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STUDIES  IN  THE  PALAEOPATHOLOGY 
OF  EGYPT 


THE  UNIVERSITY  OF  CHICAGO  PRESS 
CHICAGO,  ILLINOIS 


THE  BAKER  &  TAYLOR  COMPANY 

NEW  YORK 

THE  CAMBRIDGE  UNIVERSITY  PRESS 

LONDON 

THE  MARUZEN-KABUSHIKI-KAISHA 

TOKYO,  OSAKA,  KYOTO,  FUKDOKA,  SENDAI 

THE  MISSION  BOOK  COMPANY 

SHANGHAI 


SIR  MARC  ARMANI)  RUITKR 


STUDIES  IN  THE 

PALAEOPATHOLOGY 
OF  EGYPT 


By 

SIR  MARC  ARMAND  RUFFER,  Kt.,  C.M.G.,  M.D. 

Late  President  of  the  Quarantine  Council  of  Egypt;  formerly  Director  of  the 

British  Institute  of  Preventive  Medicine;  Professor  of  Bacteriology  in  the 

Cairo  Medical  School;  Member  of  the  Indian  Plague  Commission,  etc. 


Edited  by 

ROY  L.  MOODIE,  Ph.D. 

Professor  of  Anatomy  in  the  University  of  Illinois 


THE  UNIVERSITY  OF  CHICAGO  PRESS 
CHICAGO,  ILLINOIS 


135" 

I93LI 


Copyright  1921  By 
The  University  of  Chicago  Press 


All  Rights  Reserved 
Published  October  192 


Coniposed  and  Printed  By 

The  University  of  Chicago  Press 

Chicaeo,  Illinois,  U.S.A. 


PREFACE 

Sir  Marc  Armand  Ruffer,  whose  Studies  in  Palaeo pathology  con- 
stitute this  volume,  had  intended  to  retire  from  active  duty  in  1919 
and  devote  his  attention  to  the  preparation  of  a  work  dealing  with 
his  antiquarian  studies  of  ancient  Egypt.  The  present  collection 
of  papers  issued  under  the  direction  of  his  wife,  Lady  Ruffer,  is 
intended  to  replace  that  proposed  undertaking.  While  the  details 
of  his  plan  are  uncertain,  since  he  left  no  notes  on  the  project,  it 
has  been  deemed  best  to  select  only  those  studies  which  deal  with 
the  evidences  of  disease  in  ancient  Egypt.  These  by  no  means 
represent  his  life's  work,  but  are  rather  the  result  of  one  of  his 
keenest  interests  during  the  twenty  years  of  his  residence  in  Egypt. 

When  Sir  Armand  Ruffer  left  in  December,  1916,  on  his  mission 
to  Salonika,  where  he  had  gone  to  reorganize  the  sanitary  service 
of  the  Greek  Provisional  Government,  he  left  with  Lady  Ruffer  the 
titles  and  notes  of  several  unpublished  papers  which  he  intended  to 
finish  on  his  return.  Since  his  death  at  sea  in  the  spring  of  191 7, 
as  he  was  returning  from  Salonika,  Lady  Ruffer  has  issued  five  of 
these  studies.  Two  of  them,  "Some  Recent  Researches  on  Pre- 
historic Trephining"  and  "Arthritis  Deformans  and  Spondylitis 
in  Ancient  Egypt,"  appeared  in  19 18  in  the  Journal  of  Pathology 
and  Bacteriology  under  the  title  "Studies  in  Paleopathology."  A 
third  was  printed  by  the  Geological  Survey  of  Egypt,  with  the  title 
"Studies  in  Palaeopathology,  A  Pathological  Specimen  Dating  from 
the  Lower  Miocene  Period,"  describing  spondylitis  in  an  early 
crocodile. 

His  Food  in  Egypt  has  been  printed  in  quarto  by  the  Institut 
d'Egypt,  and  his  "Consanguineous  Marriages  among  Egyptian 
Kings"  in  the  History  of  Medicine  section  of  the  Proceedings  of  the 
Royal  Society  of  Medicine  in  London.  One  study,  that  on  diseases 
of  the  teeth  in  ancient  Egypt,  is  published  in  a  recent  number  of 
the  American  Journal  of  Physical  Anthropology.  Another  study, 
with  the  title  ".  \  l<  ohol  ;i  nd  \l(  oholism  in  Ancient  Egypt,"  is  regarded 
by  Lady  Ruffer  and  her  advisers  as  too  incomplete  for  publication. 


vi  PREFACE 

The  present  work  is  the  first  separate  volume  to  be  devoted 
entirely  to  a  discussion  of  paleopathology,  although  there  are 
several  large  memoirs  which  have  devoted  considerable  space  to  an 
account  of  ancient  pathology.  Such,  for  instance,  are  the  works  of 
G.  Elliot  Smith  and  F.  Wood  Jones  in  the  Report  of  the  Archaeologi- 
cal Survey  of  Nubia  and  that  of  Lortetand  Gaillard  on  the  mummified 
fauna  of  Egypt.  Sir  Armand  Ruffer  made  the  first  move  toward 
establishing  the  science  of  paleopathology  as  a  distinct  subject, 
and  he  gave  the  first  definition  of  the  science  in  medical  literature; 
although  there  had  been  a  prior  definition  of  the  subject  by  Ameri- 
can palaeontologists.  Paleopathology  has  an  especial  appeal  to 
students  of  medical  literature  and  particularly  to  those  who  find  an 
interest  and  a  delight  in  the  history  of  medicine.  The  subject  is  of 
importance  also  to  Egyptologists  in  showing  them  something  of  the 
intimate  life  of  the  makers  of  the  pyramids. 

Acknowledgment  is  gladly  made  the  publishers  and  editors  of 
the  Annals  of  Medical  History,  the  Journal  of  Pathology  and  Bacteri- 
ology, the  British  Medical  Journal,  the  Cairo  Scientific  Journal,  the 
Memoir es  presentes  a  I'lnstitut  d'Egypte,  the  Bulletin  de  la  Societe 
Archeologique  d'Alexandrie,  the  American  Journal  of  Physical 
Anthropology,  and  Professor  Karl  Sudhoff,  of  Leipzig,  for  their  kind 
permission  to  reprint  the  studies  in  the  present  volume.  Professor 
James  Ritchie,  of  Edinburgh,  has  granted  the  use  of  twenty-nine 
engravings  from  the  Journal  of  Pathology  and  Bacteriology.  It  is  a 
pleasure  to  express  to  Professor  James  H.  Breasted  our  gratitude 
for  the  use  of  his  "  Chronological  Summary  "  of  Egyptian  history, 
which,  on  his  advice,  has  been  taken  from  his  History  of  the 
Ancient   Egyptians. 

My  own  connection  with  the  volume  began  when  Lady  Ruffer 
requested  me  to  find  an  American  publisher  for  the  book.  Follow- 
ing a  request  of  mine  for  permission  to  dedicate  my  monograph  on 
the  palaeontological  evidences  of  disease,  now  in  preparation,  to 
Sir  Armand  Ruffer,  which  Lady  Ruffer  has  kindly  granted,  there 
has  grown  up  between  us  a  most  delightful  friendship.  My  first 
acquaintance  with  Sir  Armand  Ruffer's  studies  in  palaeopathology 
was  in  191 2  when  I  saw  his  "Histological  Studies  on  Egyptian 
Mummies"  in  the  library  at  the  University  of  Kansas.     Since  my 


PREFACE  vii 

work  on  evidences  of  disease  among  fossil  vertebrates  and  ancient 
men  has  a  close  connection  with  his  work  on  ancient  Egyptians,  it 
is  especially  pleasant  to  be  intrusted  by  Lady  Ruffer  with  such  an 
important  undertaking  as  the  issuing  of  her  husband's  Studies  in 
the  Palaeo •pathology  of  Egypt. 

Roy  L.  Moodie 

Department  or  Anatomy 

College  of  Medicine 

University  of  Illinois 

Chicago,  Illinois 


CONTENTS 

PAGE 

List  of  Illustrations xi 

Biographical  Sketch xiii 

Bibliography  of  the  Writings  of  Sir  Marc  Armand  Ruffer, 

1888-1920 xvii 

Note  on  the  Histology  of  Egyptian  Mummies 1 

Pott'sche  Krankheit  an  einer  agyptischen  Mumie  aus  der  Zeit 

der  21.  dynastie  (um  iooo  v.  chr.) 3 

Remarks  on  the  Histology  and  Pathological  Anatomy  of  Egyptian 

Mummies n 

Note  on  the  Presence  of  "Bilharzia  haematobia"  in  Egyptian 

Mummies  of  the  Twentieth  Dynasty  (1250-1000  b.c.)  .  .  18 
On  Arterial  Lesions  Found  in  Egyptian  Mummies  (1580  b.c. — 

525  a.d.) 20 

An  Eruption  Resembling  That  of  Variola  in  the  Skin  of  a  Mummy 

of  the  Twentieth  Dynasty  (1 200-1 100  b.c.) 32 

On  Dwarfs  and  Other  Deformed  Persons  in  Ancient  Egypt  .       .  35 

Histological  Studies  on  Egyptian  Mummies 49 

On  Osseous  Lesions  in  Anclent  Egyptians 93 

Notes  on  Two  Egyptian  Mummies  Dating  from  the  Persian 

Occupation  of  Egypt  (525-332  b.c.) 127 

On  Pathological  Lesions  Found  in  Coptic  Bodies  (400-500  a.d.)  .  139 

On  the  Diseases  of  the  Sudan  and  Nubia  in  Ancient  Times     .       .  156 

Pathological  Notes  on  the  Royal  Mummies  of  the  Cairo  Museum  166 
A  Tumour  of  the  Pelvis  Dating  from  Roman  Times  (250  a.d.)  and 

Found  in  Egypt 179 

A  Pathological  Specimen  Dating  from  the  Lower  Miocene  Period  184 

Some  Recent  Researches  on  Prehistoric  Trephining       .       .       .  194 

Arthritis  Deformans  and  Spondylitis  in  Ancient  Egypt  .  .  .  212 
A  Study  of  Abnormalitles  and  Pathology  of  Ancient  Egyptian 

Teeth 268 

On  the  Physical  Effects  of  Consanguineous  Marriages  in  the 

Royal  Families  of  Ancient  Egypt 322 

Appendix 358 

Index 367 


LIST  OF  ILLUSTRATIONS 

FACING 
PAGE 

Sir  Marc  Armand  Ruffer Frontispiece 

A  Trephined  Skull Text  figure,  page  200 

Plate  I.    A  Mummy  of  a  Priest  of  Ammon  with  Pott's  Disease    .     .  10 

Plate  II.    Muscle  Fibers  and  Fungus  from  the  Abscess   ....  10 

Plate  III-V.    Arterial  Lesions  from  Egyptian  Mummies  ....  30 

Plate  VI.    Lesions  of  Variola  in  the  Skin  of  a  Mummy     ....  34 

Plate  VII.    The  Dwarf  Chnoum-Hotep 48 

Plate  VEIL    Achondroplastic    Dwarfs    Depicted    on    Walls    of 

Tombs 48 

Plate  IX.    Other  Achondroplastic  Dwarfs 48 

Plate  X-XI.    Deformed  Persons  in  Ancient  Egypt 48 

Plate  XII.    Embalmed  Liver  with  Image 92 

Plate  XIII.    Embalmed  Stomach  and  Intestines 92 

Plate  XIV.    Embalmed  Lung  and  Heart 92 

Plate  XV-XXII.    Histology  of  Various  Organs  from  Egyptian 

Mummies 92 

Plate  XXIII-XXXI.    Osseous  Lesions  of  Ancient  Egyptians     .  126 

Plate  XXXII-XXXVIII.    Egyptian  Mummies   Dating  from    the 

Persian  Occupation 138 

Plate  XXXLX-XLIV.    Osseous    Lesions    Found    in    Coptic 

Bodies 154 

Plate  XLV-XLVI.    An  Osteosarcoma  of  the  Pelvis 182 

Plate  XLVII-XLVIII.    Spondylitis    Deformans    in    a    Miocene 

Crocodile 192 

Plate  XLIX-LIV.    Arthritis  Deformans  and  Spondylitis  in  An- 
cient Egyptians 266 

Plate  LV-LXII.    Lesions   of  the  Teeth  and  Jaws   of  Ancient 

Egyptians 320 

Plate  LXIII-LXXI.    Ancient  Royal  Egyptians  as  Seen  in  Their 

11        1    11  is,  Tombs,  and  Coins 356 


BIOGRAPHICAL  SKETCH1 

Original  investigation  in  medical  history  of  late  years  has  been 
furthered  in  remarkable  ways  by  archaeologists,  anthropologists, 
numismatists,  antiquarians,  collectors  of  engravings,  sinologists, 
Egyptologists,  and  particularly  by  travelers  and  explorers.  Indeed, 
the  journey  method  of  Sudhoff  goes  to  show  that  he  who  enjoys  the 
advantages  of  travel  is  much  more  likely  to  turn  up  new  facts  than 
the  stationary  investigator.  One  of  the  most  prominent  exponents 
of  this  new  tendency  was  Sir  Marc  Armand  Ruffer,  late  president 
of  the  Sanitary  Council  of  Egypt,  who  lost  his  life  at  sea  during  the 
spring  of  191 7  on  his  return  from  Salonika,  where  he  had  gone  to 
reorganize  the  sanitary  service  of  the  Greek  Provisional  Govern- 
ment. He  made  his  mark  in  the  medical  history  of  ancient  Egypt 
by  his  contributions  to  its  paleopathology,  in  particular  the  palaeo- 
histology  of  the  pathological  lesions  found  in  mummies  of  the 
XVIIIth-XXVIIth  Dynasties. 

He  was  born  at  Lyons,  France,  in  1859,  the  son  of  the  late  Baron 
Alphonse  Jacques  de  Ruffer.  His  mother  was  a  German.  He  was 
educated  at  Brasenose  College,  Oxford,  where  he  took  his  B.A. 
degree  in  1883,  and  at  University  College,  London,  becoming 
Bachelor  of  Medicine  and  Surgery  in  1887  and  Doctor  of  Medicine 
in  1889.  He  then  became  a  pupil  of  Pasteur  and  Metchnikoff  at 
the  Pasteur  Institute,  devoting  special  study  to  the  then  novel 
subject  of  phagocytosis.  In  his  papers  of  1890,  he  gave  an  early 
and  timely  exposition  of  Metchnikoff's  concept  of  inflammation  as 
a  protective  mechanism  against  infection,  particularly  in  the  intesti- 
nal canal.  He  described  the  diphtheritic  membrane  as  "a  battle- 
field," in  which  pathogenic  bacteria  and  amoeboid  leucocytes 
contend  for  mastery.  In  1891,  Ruffer  became  the  first  director  of 
the  British  Institute  of  Preventive  Medicine,  his  assistant  being 
his  wife,  Alice  Mary  Ruffer,  who  prepared  many  colored  drawings. 
At  Metchnikoff's  instance,  Ruffer  and  Plimmer  took  up  the  study 

'  Slightly  modified  from  a  memorial  notice  by  F.  H.  Garrison,  Annals  of  Medical 
History,  I  (1919),  218. 


xiv  BIOGRAPHICAL  SKETCH 

of  cancer  and  established  the  provisional  status  of  the  quasi-parasitic 
formations  in  cancer  cells.  While  testing  the  new  diphtheritic 
serum  at  the  Institute,  Ruffer  fell  a  victim  to  the  disease,  and  he 
was  so  severely  smitten  with  the  paralytic  sequelae  that  he  felt 
compelled  to  resign  his  directorship.  He  then  went  to  Egypt  for 
recuperation  and  subsequently  took  up  his  permanent  residence  at 
the  Villa  Menival,  Ramleh. 

Ruffer  was  one  of  the  ablest  organizers  of  medical  administra- 
tion in  recent  times.  He  did  much  to  make  the  present  Lister 
Institute  what  it  is  today,  became  professor  of  bacteriology  in  the 
Cairo  Medical  School  (1896),  which  he  reorganized,  and  was  the 
president  of  the  Sanitary,  Maritime,  and  Quarantine  Council  of 
Egypt  (1901-17),  in  which  office  he  was  instrumental  in  ridding 
Egypt  of  cholera  by  rigorous  hygienic  policing  of  the  routes  of 
pilgrimage  at  the  Tor  Station  and  elsewhere.  In  this  work  he 
enjoyed  the  confidence  and  support  of  both  Lord  Cromer  and  Lord 
Kitchener.  He  served  on  the  Indian  Plague  Commission,  was 
Egyptian  delegate  to  sanitary  conferences  of  1903,  1907,  and  1911, 
and  from  the  outbreak  of  the  war  was  highly  efficient  as  head  of 
the  Red  Cross  in  Egypt.  He  was  the  recipient  of  many  honors  and 
decorations,  and  was  knighted  in  1916.  A  man  of  the  world  in  the 
widest  sense,  he  was  a  remarkable  linguist,  a  talented  violoncellist, 
and  an  expert  at  his  favorite  game  of  billiards. 

In  December,  1908,  in  connection  with  the  excavations  made  in 
Nubia  by  Reisner,  Elliot  Smith,  Wood  Jones,  and  Derry  prior  to 
the  flooding  of  the  country  by  the  raising  of  the  Assuan  dam  (1907), 
Ruffer  began  to  exhibit  microscopic  sections  of  pathological  lesions 
in  mummies  at  the  Cairo  Scientific  Society.  In  this  field  Fouquet 
was  the  pioneer  (1889),  but  Ruffer  made  it  his  own  by  his  expert 
skill  in  microtomic  technique  and  staining  methods.  To  overcome 
the  hard,  brittle,  and  friable  character  of  the  tissues,  before  cutting 
them  with  a  Minot  microtome,  he  softened  them  in  a  solution  of 
alcohol  and  sodium  bicarbonate,  with  subsequent  hardening  in 
alcohol.  For  this  new  branch  of  pathological  histology  he  devised 
the  term  "paleopathology."  His  "preliminary  note"  of  1909 
{British  Medical  Journal,  I  [1909],  1005)  was  followed  by  a  striking 
series  of  papers  on  the  presence  of  Bilharzia  haematobia  in  Egyptian 


BIOGRAPHICAL  SKETCH  xv 

mummies  of  the  XXth  Dynasty,  1250-1000  B.C.  (ibid.,  I  [1910],  16), 
on  a  varioloid  eruption  in  the  skin  of  a  mummy  of  the  same  period 
(Journal  of  Pathology  and  Bacteriology,  Cambridge,  XV  [1910-n], 
1-3, 1  pi.) ,  on  arterial  lesions  in  mummies  of  1 580  B.C. — 525  a.d.  (ibid., 
453-62,  3  pis.),  on  the  osseous  lesions  in  Egyptian  skeletons,  ranging 
from  2980  B.C.  to  the  Greek  period  (ibid.,  XVI  [1911-12],  439-65, 
9  pis.),  on  dental,  osseous,  and  articular  lesions  in  Coptic  bodies  of 
400-500  a.d.  (ibid,  XVIII  [1913-14],  149-62,  6  pis.),  on  a  tumor  of  the 
pelvis  from  the  catacombs  of  Kom  el  Shougafa,  250  a.d.  (ibid., 
480-84,  2  pis.),  and  a  monograph  on  "Histological  Studies  on  Egyp- 
tian Mummies"  (Cairo,  1911).  In  1 910,  Elliot  Smith  and  Ruff er  de- 
scribed a  case  of  Pott's  disease  in  a  mummy  of  the  XXIst  Dynasty, 
ca.  1000  B.C.  (Giessen,  1910),  perhaps  the  earliest  landmark  we  have 
in  the  history  of  tuberculosis.  In  these  studies  Ruffer  showed  the 
presence  of  calcified  Bilharzia  eggs  in  the  kidneys  of  two  mummies, 
a  common  cause  of  prehistoric  haematuria,  as  shown  in  the  hiero- 
glyphs and  medical  papyri;  also  the  common  occurrence  of  arthri- 
tis, spondylitis  deformans,  dental  caries,  rarefying  periodontitis, 
pyorrhea  alveolaris,  Bouchard's  nodes,  malarial  enlargement  of  the 
spleen,  biliary  calculi,  and  particularly  arteriosclerosis  (atheroma) 
which  was  found  even  in  the  aorta  of  Ramses  II,  and  was  as  fre- 
quent three  thousand  years  ago  as  it  is  today.  Its  causation  Ruffer 
leaves  an  open  question,  since,  in  his  view,  alcohol,  tobacco,  meat 
diet,  strenuous  exercise,  and  "wear  and  tear"  could,  none  of  them, 
have  availed  to  produce  it.  His  final  studies  of  dental  and  osseous 
lesions  in  specimens  dug  up  at  Faras  (100  B.C. — -300  a.d.)  and  at 
Merawi  (750-500  B.C.)  in  the  Sudan  (Sudhojf's  Mitth.,  XIII  [1914], 
453)  led  him  to  the  conclusion  that  these  people  were  short  lived, 
dying  before  fifty.  The  war  interrupted  his  work,  which  was  cut 
short  forever  by  his  untimely  death,  but  he  had  already  planned 
a  volume  of  studies  which  is  represented  by  the  present  collection 
of  papers. 

Ruffer's  large-hearted,  sympathetic  personality  made  him  well 
loved  by  every  class  and  nationality  in  the  cosmopolitan  city  of 
Alexandria.  Some  native  pashas  on  the  Municipal  Council,  of 
which  Ruffer  was  for  some  years  vice-president,  remarked  to  Lady 
Ruffer  after  her  husband's  death  that  no  one  had  ever  been  so 


xvi  BIOGRAPHICAL  SKETCH 

mourned  and  regretted  by  them  as  he  even  after  three  years. 
A  young  medical  officer  remarked,  during  the  war:  "Sir  Ruffer 
always  treats  us  as  if  we  were  his  equals;  he  listens  sympathetically 
to  all  that  interests  us,  and  never  talks  down  to  us." 

Ruffer's  love  for  the  game  of  billiards  has  already  been  men- 
tioned by  Dr.  Garrison,  and  it  is  interesting  to  learn  also  of  his  great 
love  for  music;  being  an  accomplished  celloist  and  possessed  of  a 
rich  baritone  voice,  he  and  Lady  Ruffer  spent  many  delightful 
evenings  at  the  piano. 

Among  other  brilliant  traits  was  his  unusual  pentecostal  gift, 
a  real  gift  of  tongues,  unusual  even  for  a  versatile  European.  This 
gift  was  a  very  real  aid  to  him  in  his  work  on  the  Quarantine 
Council,  where  he  had  to  come  in  contact  with  representatives  of 
so  many  nationalities,  often  being  able  to  converse  with  them  in 
their  native  tongue.  This  ability,  added  to  his  tact  and  discretion 
in  handling  the  difficult  affairs  of  the  Council  which  often  involved 
as  many  as  eighteen  nations,  brought  his  efforts  to  establish  quaran- 
tine stations  on  the  boarder  lands  to  a  success.  His  greatest 
monument  of  all,  perhaps,  is  the  quarantine  station  at  El  Tor, 
established  for  the  return  of  Mecca  pilgrims  in  the  Peninsula  of 
Sinai,  where  he  encouraged  research  work  on  plague,  cholera, 
and  dysentery,  and  from  which  station  several  of  his  own  studies 
were  issued. 

Ruffer's  friend  and  co-worker  for  many  years,  Harry  G.  Plimmer, 
says  in  his  obituary  notice  in  Nature,  May  10, 1917:  "As  a  colleague 
Ruffer  was  ideal,  ever  ready  to  help  and  advise,  and  never  thinking 
of  himself;  and  he  was  one  who  had  the  truest,  kindliest,  and  most 
appreciative  affection  for  his  many  friends." 

The  loss  of  such  a  man  is  truly  a  great  one,  and  this  volume  of 
his  studies  will  go  far  to  keep  alive  his  memory  among  men  with 
whom  he  so  loved  to  work  and  live. 


BIBLIOGRAPHY    OF    THE    WRITINGS    OF    SIR    MARC 
ARMAND  RUFFER  1888-1920 

i.  "Sur  l'elimination  par  les  urines  des  matieres  solubles  vaccinantes  fabriquees 
par  les  microbes  en  dehors  de  rorganisme."  Comptes  rendus  des  seances 
de  V  Academie  des  Sciences,  1888,  pp.  1-3. 

2.  The  same  (cont'd).     Comptes  rendus  des  seances  de  la  Sociele  de  Biologie, 

XL  (October  20,  1888),  696-97.     (With  M.  Charrin.) 

3.  "Mecanisme  de  la  fievre  dans  la  maladie  pyocyanique."     Comptes  rendus 

des  seances  de  la  Societe  de  Biologie,  XLI   (March    9,    1889),    208-10. 
(With  M.  Charrin.) 

4.  "Les  matieres  solubles  vaccinantes  dans  le  sang  des  animaux."    1889.    2  pp. 

5.  "Influence  du  systeme  nerveux  sur  l'infection."     1889.     2  pp. 

6.  "Rabies  and  Its  Preventive  Treatment."    Lecture  given  at  the  Society 

of  Arts,  December  6,  1889.     9  pp. 

(The  above  were  written  while  working  at  the  Pasteur  Institute,  Paris.) 

7.  "Nature  of  the  Disease  Produced  by  Inoculation  of  the  Bacillus  Pyo- 

cyaenus."     1889.    Paper  read  before  University  College  Medical  Society, 
March  7,  1889.    33  pp. 

8.  "Remarks  on  the  Prevention  of  Hydrophobia  by  M.  Pasteur's  Treatment." 

Brit.  Med.  Jour.,  London,  II  (1889),  637-43. 

9.  "On  the  Phagocytes  of  the  Alimentary  Canal."     Quart.  Jour.  Micros.  Sci., 

XXX  (February,  1890),  481-505.     1  pi. 

10.  "On  the  Destruction  of  Micro-Organisms  by  Amoeboid  Cells."  Paper 
read  before  British  Medical  Association,  August  30,  1890.  Brit.  Med. 
Jour.,  London,  II  (1890),  491-93.  ■ 

11.  "Chronic  Hydrocephalus,"  Part  I.  Reprinted  from  Brain,  XIII  (1890), 
117-44.  Abstract  from  thesis  written  to  obtain  the  degree  of  Doctor  of 
Medicine  at  the  University  of  Oxford,  lune,  1888. 

12.  "Chronic  Hydrocephalus,"  Part  II.     Brain,  XIII  (1890),  240-69. 

13.  "On  the  Destruction  of  Micro-Organisms  during  the  Process  of  Inflamma- 
tion." Brit.  Med.  Jour.,  London,  I  (1890),  1 177-83.  2  pb.  of  pencil  draw- 
ings by  Lady  Ruffer. 

14.  "Preliminary  Note  on  Processes  Taking  Place  in  the  Diphtheritic  Mem- 
brane."   Brit.  Med.  Jour.,  London,  II  (July  26,  1890),  202-3. 

15.  "Recherches  sur  la  destruction  des  microbes  dans  les  cellules  ameboides 
dans  l'inflammation."  1890.  21  pp.  (This  paper  is  a  continuation 
and  enlargement  of  the  subject  of  Paper  13.) 

16.  "Recent  Advances  in  Bacteriology."    Medical  Annual,  1892.     14  pp.  and 

2. pis.  of  water-color  drawings  by  Lady  Ruffer. 


xviii  BIBLIOGRAPHY 

17.  "Immunity  against  Microbes,"  Part  I.  Quart.  Jour.  Micros.  Sci.,  XXXII 
(1891),  99-109. 

18.  "Immunity  against  Microbes,"  Part  II.    Quart.  Jour.  Micros.  Sci.,  XXXII 

(1891) ,  41 7-50.     2  double-page  pis.  of  water-color  drawings  by  Lady  Ruffer. 

19.  "Remarks  Made  at  the  Discussion  on  Phagocytosis  and  Immunity  at  the 
Pathological  Society  of  London,  March  15,  1892."  Brit.  Med.  Jour., 
London,  I  (1892),  591-96. 

20.  "The  New  Science — Preventive  Medicine."  The  Nineteenth  Century, 
December,  1891.     19  pp. 

si.  "Further  Investigations  on  the  Destruction  of  Micro-Organisms  by 
Amoeboid  Cells."    Lancet,  II  (December  26,  1891),  377. 

22.  "Preliminary  Note  on  Some  Parasitic  Protozoa  Found  in  Cancerous 
Tumours."  Brit.  Med.  Jour.,  London,  II  (July  16,  1892),  113.  (With 
J.  H.  Walker.) 

23.  "Second  Note  on  Parasitic  Protozoa  in  Cancerous  Tumours."  Brit. 
Med.  Jour.,  London,  II  (November  5,  1892),  993.     (With  J.  H.  Walker.) 

24.  "On  Some  Parasitic  Protozoa  Found  in  Cancerous  Tumours."  Jour. 
Path,  and  Bacleriol.,  I  (1892),  198-215.  3  pis.  of  water-color  drawings  by 
Lady  Ruffer.     (With  J.  H.  Walker.) 

25.  "Do  the  Interests  of  Mankind  Require  Experiments  on  Living  Animals, 
and  If  So,  Up  to  What  Point  Are  They  Justifiable  ?"  Remarks  made  at  the 
Church  Congress  of  1892.     5  pp. 

26.  "The  Morality  of  Vivisection."  The  Nineteenth  Century,  November, 
1892.     6  pp. 

27.  "Should  Experiments  on  Animals  Be  Prohibited  by  Law?"    Lit.  Rev., 

1892.    8  pp. 

28.  "The  British  Institute  of  Preventive  Medicine."  Paper  read  to  further 
its  objects  at  Birmingham,  1892. 

29.  "On  Protozoa  and  Cancer."  Trans.  Path.  Soc.  Lond.,  XLIV  (1893), 
209-16.     1  pi.  of  drawings  by  Lady  Ruffer. 

30.  "  Further  Researches  on  Parasitic  Protozoa  Found  in  Cancerous  Tumours." 
Jour.  Path,  and  Bacterid,  II  (October,  1893),  3-25.  4  pis.  colored.  (With 
H.  G.  Plimmer.) 

31.  "A  Visit  to  the  Institut  Pasteur,  by  an  Old  Student."  Brit.  Med.  Jour., 
London,  I,  January  7,  1893. 

32.  "The  Celebration  of  Louis  Pasteur's  Seventieth  Birthday:  Its  Significa- 
tion."   Med.  Mag.,  February,  1893.     10  pp. 

33.  "Sur  les  parasites  des  tumeurs  epitheliales  malignes."  Extrait  du  Traite 
de  pathologie  generate,  Tome  II  (decembre,  1895).  12  pp.  and  1  pi.  wood- 
cut reproduction  of  water-color  illustrations  by  Lady  Ruffer. 

34.  "Discussion  on  Diphtheria  ....  and  Its  Treatment  by  Serum."  Glas- 
gow Med.  Jour.,  July,  1895.     7  pp. 

35.  "Measures  Taken  at  Tor  and  Suez  against  Ships  Coming  from  the  Red 
Sea  and  the  Far  East."    Lancet,  London,  II  (December  30,  1899),  1801-8. 


BIBLIOGRAPHY  xix 

36.  "A  Contribution  to  the  Study  of  the  Presence  and  Formation  of  Agglu- 
tinins in  the  Blood."     14  pp.     (With  M.  Crendiropoulo.) 

37.  "On  the  Toxic  Properties  of  Bile  and  on  Antihaemolytic  (Haemosozic) 

Serum."     Jour.  Path,  and  Bacteriol.,  Edinburgh  and  London,  IX  (1903-4), 
278-3^.     (With  M.  Crendiropoulo.) 

38.  "Note  on  Haemosozic  Sera.     3  pp.     (With  M.  Crendiropoulo.) 

39.  "On  Haemolytic  and  Haemosozic  Serums."  Brit.  Med.  Jour.,  London, 
II  (1904),  58r. 

40.  "On  Substances  Favouring  and  Inhibiting  the  Action  of  the  Haemolysins 
of  Bile  and  Serum."     9  pp.     (With  M.  Crendiropoulo.) 

41.  "Sur  le  pouvoir  hemosozique  du  chlorine  du  sodium  et  son  mode  d'action." 

if  pp.     (With  M.  Crendiropoulo.) 

42.  "On  a  Hitherto  Undescribed  Change  in  the  Urine  of  Patients  Suffering 
from  Nephritis."  Brit.  Med.  Jour.,  London,  II  (1905),  544-  (With  G. 
Calvocoressi.) 

43.  "On  the  Lesions  Produced  by  Oxyuris  Vermicularis."  Brit.  Med.  Jour., 
London,  I  (1901),  208-9.  ' 

44.  "  Contribution  to  the  Technique  of  Bacteriology."  Brit.  Med.  Jour., 
London,  II  (1900),  1305-6.     1  fig.     (With  M.  Crendiropoulo.) 

45.  "Note  on  the  Dialysis  of  Toxins  through  Collodion  Walls.  if  pp.  (With 
M.  Crendiropoulo.) 

46.  "On   Some   Results   Obtained   by   Disinfection   and   Isolation   against 

Cholera."    3!  pp.     (With  Zackariades  Bey.) 

47.  "On  the  Lysogenic  and  Haemosozic  Properties  of  Urine."  23  pp.  (With 
M.  Crendiropoulo  and  G.  Calvocoressi.) 

48.  "Researches  on  the  Bacteriological  Diagnosis  of  Cholera  by  the  Medical 
Officers  at  the  Quarantine  Council  of  Egypt,  under  the  Direction  of  Sir 
Armand  Ruffer."    Brit.  Med.  Jour.,  London,  I  (1907),  735-42. 

49.  "Perpetual  Sanitary  Supervision  of  Ports:  Permanent  Measures  to  Be 
Taken  in  Harbours."  Bericht  iiber  den  XIV.  Intern.  Kongress fiir  Hygiene 
und  Demographie,  Berlin,  1907.     95  pp. 

50.  "On  the  Etiology  of  Dysentery."    Brit.  Med.  Jour.,  London,  II  (Septem- 

ber 25,  1909),  862-66.     (With  J.  G.  Willmore.) 

51.  "The  Serum  Treatment  of  Dysentery."    Brit.  Med.  Jour.,  November  12, 

1910,  pp.  1-12.     (With  J.  G.  Willmore.) 

52.  "Sur  la  guerisondutetanos  experimental^  chezlecobaye."  1913.  Comples 
rendus  des  seances  de  la  Sociele  de  Biologie,  Paris,  LXXIV  (1913),  1277-79. 
(With  M.  Crendiropoulo.) 

53.  "Sur  la  guerison  du  tetanos  experimentale  des  cobayes.    Presse  Medicale, 

November  8,  1913.     19  pp.     (With  M.  Crendiropoulo.) 

54.  "Note    on    the    Anti-Haemolytic    (Haemosozic)    Properties    of    Normal 

Urine."    Brit.  Med.  Jour.,  London,  I  (1904),  1418. 

55.  "Note  on  the  Presence  of  'Bilhurzia  Ilacmatobia'  in  Egyptian  Mummies 

of  the  XXth  Dynasty."     Brit.  Med.  Jour., London,  I  (January  1, 1910),  16. 


xx  BIBLIOGRAPHY 

56.  "Remarks  on  the  Histology  and  Pathological  Anatomy  of  Egyptian 
Mummies."     Cairo  Sci.  Jour.,  IV  (January,  1910),  1-5. 

57.  "  Note  on  an  Eruption  Resembling  That  of  Variola  in  the  Skin  of  a  Mummy 
of  the  XXth  Dynasty."  Jour.  Path,  and  Bacteriol.,  XV  (1910),  1-3. 
(With  A.  R.  Ferguson.) 

58.  "Potts'che  Krankheit  an  einer  agyptischen  Mumie  aus  der  Zeit  der  21. 
Dynastie."  Zur  hislorischen  Biologie  der  Krankheitserreger,  3.  Heft, 
Giessen,  1910.     2  pis.,  1  colored,  by  Lady  Ruffer.     (With  Elliot  Smith.) 

59.  "On  Arterial  Lesions  Found  in  Egyptian  Mummies."  Jour.  Path,  and 
Bacteriol.,  XV  (191 1),  453-62.     3  pis. 

60.  "On  Dwarfs  and  Other  Deformed  Persons."  Bull,  de  la  Soc.  Archeol. 
d'Aexandrie,  No.  13  (191 1),  1-17.  3  pis.  of  photographs,  2  pis.  of  drawings 
from  the  tombs,  by  Lady  Ruffer. 

61.  "Histological  Studies  on  Egyptian  Mummies."  Memoires  presenles  a  I'ln- 
slitut  Egyplien,  Tome  VI,  Fasc.  hi,  39  pp.,  n  pis.,  roy.  4to  (mars,  1911). 

62.  "On  Osseous  Lesions  in  Ancient  Egyptians."  Jour.  Path,  and  Bacteriol., 
XVI  (1912),  439-65.     9  pis.  of  photographs.     (With  A.  Rietti.) 

63.  "Notes  on  Two  Egyptian  Mummies  Dating  from  the  Persian  Occupation 
of  Egypt."  Bull,  de  la  Soc.  Archeol.  d'Alexandrie,  No.  14  (1912),  1-18. 
7  pis.  of  photographs.     (With  A.  Rietti.) 

64.  "Pathological  Notes  on  the  Royal  Mummies  of  the  Cairo  Museum."  Mit- 
theil.  z.  Gesch.  der  Med.  undderNaturwissensch.,No.  56,  XIII  (1914),  239-68. 

65.  "Note  on  the  Diseases  of  the  Sudan  and  Nubia  in  Ancient  Times."  Mit- 
theil.  z.  Gesch.  der  Med.  und  der  Naturwissensch.  No.  58,  XIII  (1914), 
No.  6,  453-60. 

66.  "On  Pathological  Lesions  Found  in  Coptic  Bodies."  Jour.  Path,  and 
Bacteriol.,  XVIII  (1913),  149-62.     2  pis. 

67.  "On  a  Tumour  of  the  Pelvis  Dating  from  the  Roman  Times  and  Found 
in  Egypt."  Jour.  Path,  and  Bacteriol.,  XVIII  (1914),  480-84.  2  pis. 
(With  J.  G.  Willmore.) 

68.  "A  Pathological  Specimen  Dating  from  the  Lower  Miocene  Period." 
(Extrait  de  Contributions  a  I'Etude  des  Vertebres  miocenes  de  I'Egyple.) 
Cairo:  Survey  Dept.,  1917.     2  pis.     7  pp. 

69.  "The  Use  of  Natron  and  Salt  by  the  Ancient  Egyptians."  Cairo  Sci. 
Jour.,  IX  (1917),  34-53- 

70.  "Some  Recent  Researches  on  Prehistoric  Trephining."  Jour.  Path,  and 
Bacteriol.,  XXII  (1918),  90-104.     1  fig. 

71.  "Arthritis  Deformans  and  Spondylitis  in  Ancient  Egypt."  Jour.  Path, 
and  Bacteriol.,  XXII  (1918),  152-96.     6  pis.  of  photographs. 

72.  "Food  in  Egypt."     Memoires  presentes  al'Institul  Egyplien,  I  (1919),  1-88. 

73.  "On  the  Physical  Effects  of  Consanguineous  Marriages  in  the  Royal 
Families  of  Ancient  Egypt."  Proc.  Royal  Soc.  of  Med.,  Sect,  of  Hist,  of 
Med.,  London,  XII  (1919),  1-46.     27  figs. 

74.  "Abnormalities  and  Pathology  of  Ancient  Egyptian  Teeth."  Amer. 
Jour.  Phys.  Anthrop.,  Ill  (1920),  No.  3,  335-82.    8  pis. 


NOTE  ON  THE  HISTOLOGY  OF  EGYPTIAN  MUMMIES 

{British  Medical  Journal,  I  [London,  1909],  1005) 

Some  time  ago  my  friend  Professor  Elliot  Smith,  F.R.S.,  gave  me 
some  fragments  of  mummies  of  the  XXIst  Dynasty  (dating  from 
1250-1000  B.C.),  and  I  endeavored  to  examine  these  fragments  by 
histological  methods.  As  far  as  I  knew,  then,  this  was  practically 
the  first  attempt  to  study  microscopically  the  minute  structure  of 
tissues  mummified  for  about  three  thousand  years;  at  any  rate, 
I  found  nothing  bearing  on  this  subject  in  the  literature  at  my 
disposal,  but  I  was  informed  that  Professor  Looss  of  Cairo  had 
shown  the  striation  of  mummified  muscular  fibres  to  his  colleagues. 
I  demonstrated  some  of  my  sections  at  the  Sheffield  meeting  of  the 
British  Medical  Association  and  at  the  December  meeting  (1908) 
of  the  Cairo  Scientific  Club.  Quite  lately  my  friend  Mr.  Shattock 
has  read  a  paper  on  a  similar  subject  before  the  Royal  Society  of 
Medicine. 


It  was  found  impossible  to  obtain  good  microscopical  sections 
without  first  restoring,  to  some  extent  at  any  rate,  their  flexibility 
to  the  tissues,  as  their  brittleness  and  hardness  broke  the  edge  of 
the  microtome  knives;  even  when  a  fair  section  was  obtained,  this 
invariably  crumbled  up  when  transferred  to  the  slide.  I  need  not 
describe  the  various  methods  tried  and  rejected,  but  it  will  be 
sufficient  to  note  that,  by  combining  an  alkaline  salt  such  as 
carbonate  of  soda  with  a  hardening  reagent  such  as  alcohol  or 
formol,  the  mummified  tissue  placed  in  the  mixture  gradually 
swells  up  and  resumes  its  former  shape. 

The  solution  which  has  given  me  the  best  results  is  composed 
of  alcohol,  100  parts,  5  per  cent  carbonate  of  soda  solution,  60  parts. 
In  many  cases,  however,  such  a  solution  softens  the  tissues  too 
much,  and  more  alcohol  must  then  be  added. 

After  a  period  of  time,  the  length  of  which  depends  on  the  bulk 
and  nature  of  the  tissue,  the  solution  is  replaced  by  30  per  cent 


2      STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

alcohol,  and  more  alcohol  is  added  day  by  day.  After  two  or  three 
days  the  softened  tissue  is  transferred  to  absolute  alcohol,  then 
chloroform,  paraffin,  and  cut  secundum  artem.  During  these 
manipulations  the  tissue  remains  pliable,  though  it  shrinks  a  good 
deal.  Very  thin  sections  do  not  present  any  particular  advantages, 
and  I  generally  use  three  divisions  of  Minot's  microtome.  Such 
preparations,  after  maceration  in  i  in  10,000  caustic  potash,  give 
excellent  pictures. 

RESULTS 

I  have  prepared  sections  of  muscle  (voluntary,  cardiac,  and 
involuntary),  blood  vessels,  skin,  intestine,  stomach,  liver,  kidney, 
bone,  mammary  glands,  and  testicles, "and  the  main  characters  of 
all  these  organs  and  tissues  can  be  readily  recognized.  The  stria- 
tion  of  muscular  fibres,  for  instance,  the  muscular  coats,  the 
submucous  tissue,  and  occasionally  even  the  glands  of  the  intestines 
and  the  convoluted  tubules,  the  straight  tubules  and  glomeruli  of 
the  kidneys,  the  various  layers  of  the  skin  can  be  identified  with 
certainty.  I  have  no  doubt  that  coarse  pathological  changes,  such 
as  inflammation,  cirrhosis,  tubercle,  or  cancer  could  be  demonstrated 
by  this  method. 


POTT'SCHE    KRANKHEIT    AN     EINER    A.GYPTISCHEN 

MUMIE  AUS  DER  ZEIT  DER  21.  DYNASTIE 

(UM  1000  V.  CHR.)1 

(Sudhoff  und   Sticker,  Zw   historischen  Biologie  der  Krankheits- 
erreger  [Giessen,  1910],  3.  Heft) 

Es  ist  nichts  Neues,  die  Entdeckung  eines  Falles  von  Pott'scher 
Krankheit  in  Uberresten  aus  Altagypten  anzukiindigen.  Wir 
glauben  jedoch,  dass  unser  Fall  das  erste  echte  Beispiel  jener 
Krankheit  ist,  das  an  agyptischen  Mumien  gefunden  wurde,  dessen 
Wichtigkeit  durch  die  Tatsache  wachst,  dass  uns  ihr  typisches 
Bild  ermutigt  hat,  mehrere  spater  ausgegrabene  Falle  als  tuber- 
kulos  zu  identifizieren. 

Die  Wirbelsaulen  archaischer  Agypter,  welche  von  Dr.  Fouquet 
als  Beispiele  Pott'scher  Krankheit  beschrieben  wurden  (siehe  J.  de 
Morgan,  Recherches  sur  les  origines  de  I'Egypte,  Paris,  1897,  Ap- 
pendice  par  le  Dr.  Fouquet),  sind  fur  uns  typische  Beispiele  von 
Osteoarthritis,  so  wie  sie  Dr.  Wood  Jones  unter  dem  Namen 
"Spondylitis  deformans"  beschrieben  -und  abgebildet  hat.  (The 
Archaeological  Survey  of  Nubia,  Bulletin  No.  2,  Cairo,  1908,  Plate 
LIV.) 

Diese  Erkrankung  war  in  Ober-Agypten  so  verbreitet — be- 
sonders  wahrscheinlich  in  pradynastischer  Zeit — ,  dass  gelegentlich 
einer  von  uns  (G.  E.  S.)  Beweise  davon  an  jedem  ausgewachsenen 
Skelett  in  einem  grossen  allgemeinen  Begrabnisplatze  fand.  Sie 
war  auch  zur  Zeit  der  persischen  Dynastien,  zirka  525-332  v.  Chr., 
verbreitet,  und  in  Unter-Agypten  zeigen  selbst  die  Skelette  von 
makedonischen  Soldaten  und  deren  Familien  (seit  zirka  332  v.  Chr.) 
— kiirzlich  von  Dr.  Breccia  ausgegraben — oft  unverkennbare 
Merkmale  dieser  Krankheit.     (M.  A.  R.) 

Professor  Poncet  stellt  auch  die  Diagnose  tuberkuloser  Erkrank- 
ung an  der  Wirbelsaule  eines  Affen,  den  Professor  Lortet  in  einem 
alten  thebanischen  Begrabnisplatz  gefunden  (Lortet  et  Gaillard, 
/.'/  fuune  momifiee  de  I'ancienne  Egyple,  Lyon,  1905,  pp.  228-31, 
[       papei  w     mtten  with  Graf  ton  Elliot  Smith  as  senior  author. 
3 


4  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Fig.  95),  und  sagt  Seite  231:  "Ich  will  als  Beweis  hierfiir  nur  die 
Ahnlichkeit  dieser  Wirbelankylosen  mit  denjenigen  anfiihren,  die 
wir  oftmals  beim  Menschen  konstatierten  und  deren  tuberkulosen 

Ursprung  wir  dargewiesen  haben Diese  Diagnose  wird  noch 

bekraftigt  durch  die  Tatsache,  dass  die  Tuberkulose  beim  Affen  sehr 
haufig  vorkommt."1 

Wir  konnen  der  Diagnose  von  Professor  Poncet  nicht  beipflich- 
ten,  da  wir  mit  der  Mehrzahl  der  Pathologen  behaupten,  dass — 
was  auch  immer  die  Ursache  von  Spondylitis  deformans  sein  mag — 
der  Tuberkelbazillus  nicht  als  Faktor  in  deren  Atiologie  nachge- 
wiesen  worden  ist,  und  dass  eine  scharfe  Unterscheidungslinie 
zwischen  ihr  und  der  Riickenwirbeltuberkulose  (Pott'scher  Krank- 
heit)  gezogen  werden  muss. 

Einer  von  uns  (G.  E.  S.)  fand  vor  ungefa.hr  fiinf  Jahren — bei  der 
Priifung  menschlicher  Uberreste,  die  Dr.  Reisner  in  einem  Be- 
grabnisplatz  des  alten  Kaiserreiches  (Ausgrabungen  der  Hearst- 
Expedition)  in  Gizeh  entdeckt  hat — das  Skelett  eines  kleinen  Kindes 
(vielleicht  aus  der  Zeit  um  2700  v.  Chr.),  an  welchem  die  typische 
krankhafte  Veranderung  von  vorgerucktem  Hiiftleiden  zu  sehen 
war.  Obgleich  dasselbe  hochstwahrscheinlich  durch  Tuberkulose 
entstanden  war,  konnte  man  keinen  positiven  Beweis  dafiir 
erbringen. 

Im  ersten  Bulletin  des  Archaeological  Survey  of  Nubia  (p.  38) 
beschreibt  Dr.  Wood  Jones  eine  Mumie  mit  ausgesprochener  patho- 
logischer  Veranderung  des  Hiiftgelenks  (linkes  Uiosakral-Gelenk) 
und  der  letzten  beiden  Lendenwirbel.  Auch  das  linke  Ellbogen- 
gelenk  war  stark  verandert;  von  diesem  liefen  Fistelgange  aus,  die 
sich  auf  der  Hautoberflache  offneten. 

Damals  wurde  die  Diagnose  einer  tuberkulosen  Erkrankung 
gestellt,  aber  Professor  A.  R.  Ferguson  von  der  medizinischen 
Schule  in  Kairo  setzte  dem  entgegen,  dass  die  Natur  der  Knochen- 
neubildung  nicht  auf  eine  tuberkulose  Veranderung  hindeute. 
Auch  Dr.  Charles  Todd  vom  Public  Health  Department  suchte 
vergeblich  nach  Tuberkelbazillen  in  den  Lungen. 

1  "  Je  n'en  veux  pour  preuve  que  la  similitude  de  cettes  ankyloses  vertebrates  avec 
celles  que  nous  avons  maintes  fois  constatees  chez  l'homme  et  dont  nous  avons 
deraontre  l'origine  tuberculeuse.  ...  Ce  diagnostic  est  encore  corrobore  par  ce  fait 
que  la  tuberculose  est  tres  commune  chez  le  singe." 


POTT'SCHE   KRANKHEIT  5 

Seit  jener  Zeit  hat  Dr.  Derry  (im  Verlaufe  seiner  anthropolo- 
gischen  Arbeiten  im  Zusammenhang  mit  dem  Archaeological  Survey 
of  Nubia)  eine  Reihe  von  kranken  Wirbelsaulen — aus  der  Zeit  von 
2000  bis  3000  v.  Chr.  und  sogar  noch  friiher — gefunden,  die  eine  so 
vollkommne  Ahnlichkeit  mit  den  Fallen  besitzen,  die  hier  be- 
schrieben  werden  sollen,  dass — wenn  letztere  fur  tuberkulos  erklart 
werden  diirfen,  dieselbe  Diagnose  bei  der  Untersuchung  der  friiher 
gefundenen  Wirbelsaulen  gestellt  werden  muss  (siehe  Archaeological 
Survey  of  Nubia,  Bulletin  No.  3,  p.  32,  No.  4,  pp.  10,  26  und  No.  5, 
pp.  21  und  22). 

Die  Mumie,  mit  der  wir  in  diesem  Bericht  zu  tun  haben,  war  die 
irdische  Hulle  eines  Priesters  des  Amnion  aus  der  21.  Dynastie 
(zirka  1000  v.  Chr.)  und  befand  sich  unter  der  grossen  Sammlung 
menschlicher  Korper  der  Seconde  trouvaille  de  Deir  el  Bahari,  die 
1891  von  M.  Grebaut  vom  Service  des  Antiquites  in  der  Gegend 
der  grossen  thebanischen  Hauptstadt  aufgefunden  wurden. 

1904  iiberantwortete  Sir  Gaston  Maspero  (Generaldirektor  des 
Service  des  Antiquites)  vierundvierzig  dieser  Mumien  (seit  1891  im 
Museum  der  Altertumer  von  Kairo  aufbewahrt)  an  das  anatomische 
Museum  der  medizinischen  Schule  von  Kairo.  Unter  diesen  fand 
einer  von  uns  beiden  (G.  E.  S.)  die  Mumie  dieses  typischen  Buckeli- 
gen;  leider  trug  sie  aber  keinen  Zettel,  der  bezeichnet  hatte,  aus 
welchem  Sarg  sie  genommen  war,  und  auch  auf  den  diesen  Leich- 
nam  umhullenden  Leinwandbandagen  keine  Angabe,  um  uns  die 
Identifizierung  oder  die  Festsetzung  ihrer  genauen  chronologischen 
Stellung  zu  ermoglichen. 

Die  besonders  gut  erkennbare  Technik  des  Einbalsamierungs- 
vorgangs,  wie  solche  in  den  Tagen  der  21.  Dynastie  angewandt 
wurde,  ist  ausfiihrlich  anderswo  beschrieben  (G.  E.  S.,  "A  Contribu- 
tion to  the  Study  of  Mummification  in  Egypt,"  Memoires  presenles 
a  rinslitut  Egyptien,  Vol.  V,  Fasc.  1,  1906),  lasst  uns  jedoch  mit 
Sicherheit  feststellen,  dass  diese  Mumie  in  der  genannten  Zeit 
einbalsamiert  worden  war. 

Das  allgemeine  Aussehen  der  Uberreste  dieser  Mumie  eines 
jungen  erwachsenen  Mannes  wurde  in  der  von  Mrs.  Cecil  Firth 
freundlichst  verfertigten  Skizze  (Tafel  I,  Figur  1)  ausgezeichnet 
portratiert.     Tafel  I,  Figur  2,  ist  eine  unretouchierte  Photographic, 


6  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

die  die  Ansicht  des  Korpers  von  vorne  darstellt,  nachdem  die 
vordere  Korperwand  entfernt  war.- 

Augenscheinlich  hatte  hier  eine  ausgedehnte  Zerstorung  der  Mitte 
des  i .  Lendenwirbels  und  der  unteren  drei  oder  vier  Riickenwirbel 
stattgefunden;  das  Riickgrat  hatte  in  der  unteren  Riickengegend 
nachgegeben,  und  es  war  eine  ausgesprochene  unregelmassige 
Einknickung  entstanden.  Die  Riickengegend  der  Wirbelsaule 
bildet  einen  Winkel,  dessen  Spitze  in  der  Verschmelzungsstelle  des 
8.  und  9.  Riickenwirbels  liegt.  Der  erste  Lendenwirbelkorper  hat 
vorne  und  oben  einen  Ansatz  zu  einer  starken  neuen  Knochen- 
bildung  genommen  (wie  Tafel  I,  Figur  2,  gut  zeigt) ;  soweit  durch 
Priifung  mit  dem  Messer  gefunden  werden  konnte,  war  die  Kon- 
solidierung  der  Wirbelkorper  eine  vollstandige  und  keine  andere 
Knochenneubildung  zu  entdecken. 

Von  der  rechten  Seite  des  1 .  Lendenwirbelkorpers  sieht  man  eine 
breite  abgeplattete  Anschwellung  ausgehen,  die  sich  nach  unten 
langs  eines  Stranges  hinzieht,  demjenigen  entsprechend,  welchen  an 
der  linken  Seite  der  Lendenmuskel  (Musculus  psoas)  bildet,  bis  in 
die  rechte  Darmbeingrube  (Fossa  iliaca),  in  welcher  sie  sich  verliert. 
Keine  Spur  von  einer  Offnung  in  der  Haut  war  am  Oberschenkel 
oder  am  Bein  oder  in  der  Lendengegend  zu  finden,  wo  Abszesse  von 
Krankheiten  der  Wirbelsaule  sich  bei  einigen  Fallen  zu  off  nen  pfleg- 
ten,  die  einer  von  uns  im  Sektionsraum  zu  Kairo  zu  untersuchen 
Gelegenheit  hatte. 

MIKROSKOPISCHE   ITNTERSUCHUNG 

Bruchstiicke  von  Trachea,  Larynx  und  Bronchialdriisen  wurden 
mikroskopisch  nach  einer  Methode  untersucht,  die  einer  von  uns 
(M.  A.  R.)  schon  besprochen  hat.  Man  erweichte  die  Gewebe  in 
einer  Losung,  die  wie  folgt  zusammengesetzt  war: 

Alkohol 30  cc 

Wasser 50  cc 

5%  kohlensaure  Natronlbsung 20  cc 

legte  sie  dann  in  immer  konzentrierteren  Alkohol,  in  absoluten 
Alkohol,  in  Chloroform,  und  bettete  sie  schliesslich  in  Paraffin  ein. 
Schnitte  solcher  Gewebe  wurden  mit  Hamatoxylin  oder  speziell  fur 


POTT'SCHE  KRANKHEIT  7 

Tuberkelbazillen  gefarbt,  etwas  Abnormes  konnte  jedoch  nicht 
daran  entdeckt  werden. 

Mit  einer  kleinen  Trepankrone  von  ungefa.hr  1 5  mm  Durchmes- 
ser  entfernten  wir  sodann  von  dem  vermutlichen  Psoasabszess  einen 
Gewebszylinder.  Es  zeigte  sich,  dass  eine  deutliche  Hohlung,  gross 
genug,  um  einen  kleinen  Finger  durchzulassen,  die  obere  Schicht 
vom  Knochen  trennte,  und  durch  diese  Hohlung  konnte  mit  Leicht- 
igkeit  eine  Sonde  nach  dem  Oberschenkel  geschoben  werden. 
Deutliche  muskulose  Fasern  konnten  mit  blossem  Auge  nicht 
gesehen  werden. 

Behufs  Kontrolle  dieser  Beobachtung  wurde  mit  derselben 
Trepankrone  ein  Probestiick  an  der  entsprechenden  Stelle  in  der 
linken  Fossa  iliaca  entnommen.  Nur  eine  diinne  Gewebeschicht 
trennte  den  Knochen  hier  von  der  Obernache,  und  dies  war  un- 
zweifelhaft  quergestreifte  Muskelsubstanz.  So  ergab  sich  also  der 
positive  Beweis  fiir  eine  krankhafte  Veranderung  in  der  Gegend  des 
rechten  Lendenmuskels  (Muse,  psoas). 

LINKE   ODER   GESUNDE   SEITE 

Das  angebohrte  Stuck  bestand  aus  gelblich-weissem,  fleckigem 
Material  von  Aussehen  und  Konsistenz  normaler  einbalsamierter 
Muskelfaser  (siehe  Tafel  II,  B).  Es  fiihlte  sich  hart  an,  wenn 
auch  nicht  kornig,  und  kleine  biegsame  Muskelfaserstreifen  konnten 
leicht  abgetrennt  werden  (siehe  Tafel  II,  C).  Wegen  der  sehr  tief 
gelb  gefarbten  Materie,  die  die  Struktur  einbalsamierter  Gewebe 
immer  verdunkelt,  vermochte  man  nach  einfachem  Zupfen  durch 
histologische  Untersuchung  sehr  wenig  zu  finden.  Nach  der 
Erweichung  kleiner  Stiickchen  durch  12-24  Std.  in  Vioooo  Atzkali- 
losung  war  aber  die  Muskelfaser  leicht  zu  erkennen.  Die  Querstreif- 
ung  war  unverkennbar  und  an  einigen  Stellen  war  das  Sarkolemma 
nachweisbar,  doch  waren,  wie  es  meist  bei  einbalsamierten  Muskeln 
der  Fall  ist,  keine  Zellkerne  zu  unterscheiden. 

Schnitte  hiervon  wurden  auch  nach  der  oben  beschriebenen 
Methode  prapariert,  und  die  Praparate  zeigten,  dass  der  Muskel 
sehr  gut  erhalten  und  kein  Leichen-Packungsmaterial  zwischen  die 
Fasern  gedrungen  war.  Die  Querstreifung,  obgleich  gut  erkennbar, 
war  vielleicht  nicht  so  voUkommcn  erhalten  wie  an  Muskeln  anderer 


8  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Mumien.  Dieser  Punkt  ist  nicht  so  sehr  wichtig,  da  es  betracht- 
liche  Unterschiede  im  Erhaltungszustand  agyptischer  Mumien 
gibt,  selbst  bei  denjenigen  der  namlichen  Dynastie. 

RECHTE   ODER   KRANKE   SEITE 

Der  Stand  der  Dinge  auf  dieser  Seite  war  makroskopisch  und 
mikroskopisch  ein  durchaus  anderer.  Erstens  musste  man  von  der 
Oberflache  des  herausgebohrten  Stiickes  eine  verhaltnismassig 
grosse  Menge  pulverigen  schwarzen  Stoffes,  hauptsachlich  aus 
Holzkohle  bestehend,  entfernen. — Zweitens  sah  das  durch  das 
Ausbohren  erhaltene  Stuck  ganz  anders  aus  wie  dasjenige  von  der 
linken  Seite.  Es  zeigte  eine  schmutziggelbe  Farbe,  war  aber  stellen- 
weise  glanzendweiss  und  hie  und  da  mit  pechschwarzen  Flecken 
getupft  (siehe  Tafel  II,  A).  Seine  Konsistenz  war  hart,  aber  kleine 
Partien  zerkriimelten  rasch  unter  dem  Finger,  was  allein  schon 
geniigte,  um  den  Unterschied  zwischen  der  Muskelstruktur  rechts 
und  links  zu  veranschaulichen.  In  den  inneren  Partien  des  ausge- 
bohrten  Stiickes  zeigte  der  leicht  zerkriimelnde  Stoff  ein  schmutzig- 
gelbes  Aussehen  und  ein  ganz  wenig  Beimischung  des  oben 
beschriebenen  schwarzen  Pulvers. 

In  Deckglaspraparaten  konnte  man  erkennen,  dass  die  schwar- 
zen Bestandteile  des  ausgebohrten  Stiickes  fast  ganzlich  aus  klein- 
sten  Teilchen  von  Holzkohle  und  Pflanzeniiberresten  bestanden,  die 
augenscheinlich  als  Verpackungs-  oder  Ausstopfungsmaterial  ge- 
dient  hatten.  Ausserdem  fand  man  eine  gewisse  Menge  eines 
gelben  glanzenden  Stoffes  (Harz?). — Die  Bemuhungen,  aus  dieser 
schwarzen  Substanz  Schnittpraparate  zu  machen,  waren  von  keinem 
Erfolge  gekront,  da  dieser  Stoff  in  der  ihn  erweichenden  Losung 
nicht  aufquoll,  sondern  hart  und  zerbrechlich  blieb. 

Der  gelbliche  Stoff  veranderte  sich  nicht  merklich  in  der  erweich- 
enden Losung,  nichtsdestoweniger  wurden  aber  ziemlich  gute 
Erfolge  erzielt.  Die  Praparate  zeigten:  (a)  muskulose  Fasern, 
obgleich  nicht  zahlreich,  so  doch  geniigend  gut  erhalten,  um  die 
Querstreifung  und  des  Sarkolemma  zu  zeigen. 

Die  Muskelfasern  waren  (b)  in  einen  kornigen  Stoff,  bestehend 
aus  unregelmassigen  rundlichen  Korpern,  eingebettet,  von  keiner 
besonderen  Struktur,  aber  mit  Hamatoxylin  und  Eosin  (siehe  Tafel 


POTT'SCHE  KRANKHEIT  g 

II,  F)  gut  sich  farbend.  Man  war  versucht,  diese  Korper  fiir 
Leukozy ten  anzusehen ;  obgleich  aber  diese  Diagnose  nicht  unwahr- 
scheinlich  ist,  konnte  doch  kein  typisches  weisses  Blutkorperchen 
nachgewiesen  werden.  Vermischt  mit  diesen  Korperchen  war  (c) 
eine  gewisse  Menge  Holzkohle  (siehe  Tafel  II,  E  und  F)  und  eines 
gelblich-krystallartigen  Stoffes  (siehe  Tafel  II,  F),  welche  augen- 
scheinlich  Packungsmaterial  waren. 

Man  konnte  auch  (d)  eine  grosse  Anzahl  von  eiformigen  Korper- 
chen (siehe  Tafel  II,  G)  sehen,  welche  sich  mit  Hematoxylin 
schwach  und  gleichmassig  farben  liessen,  und  deren  aussere  Enden 
etwas  verdickt  waren  und  tiefer  sich  farbten  (siehe  Tafel  II,  G). 
Ihre  Konturen  waren  scharf,  und  bei  manchen  war  eine  deutliche 
Membran  zu  erkennen.  Sie  lagen  vereinzelt,  ofter  auch  in  Gruppen 
von  6  bis  12,  manchmal  sogar  von  30  bis  40  zusammengeballt.  In 
manchen  Fallen  hatten  sie  alle  gleichmassige  Struktur  (siehe  Tafel 
II,  G),  aber  manchmal  waren  sie  mehr  oder  weniger  deformiert 
(siehe  Tafel  II,  J).  Nach  ihrer  Form  und  Struktur  zu  urteilen, 
sehen  wir  sie  als  Schimmel-Sporen  an;  denn  sich  verastelnde 
Myzelien  waren  deutlich  an  vielen  Praparaten  zu  sehen  (siehe  Tafel 
II,  H).  Mikrokokken  oder  Bazillen  konnten  durch  keine  Methode 
nachgewiesen  werden. 

Um  es  kurz  zusammenzufassen:  Der  linke  Psoas  bestand  aus 
normalen  Muskelfasern;  dagegen  war  die  Oberflache  des  rechten 
Psoas  mit  einer  grossen  Menge  schwarzen  staubigen  Stoffes, 
bestehend  aus  Holzkohle,  Pflanzenfaser,  Harz  ( ?)  etc.,  als  Packungs- 
und  Ausstopfungsmaterial  gebraucht,  bedeckt.  Die  tiefen,  mehr 
gelben  Teile  bestanden  aus  Muskelfasern,  welche  in  einer  grossen 
Menge  kornigen  Stoffes  (Leukozyten  ?)  eingebettet  lagen,  vermischt 
mit  einer  gewissen  Menge  von  Holzkohle  etc.  (Packungsmaterial) 
und  Schimmel. 

SCHLUSSFOLGERUNG 

Der  mikroskopische  Befund  des  rechten  Psoas  unterstiitzt  die 
Diagnose,  zu  der  man  nach  einer  Priifung  mit  blossem  Auge  gelangte, 
namlich  das  Vorhandensein  eines  Psoasabszesses  auf  der  rechten 
Seitc. 


io  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Es  wurde  zwar  kein  Eiter  gefunden,  der  mit  Sicherheit  erkannt 
werden  konnte,  aber  man  muss  sich  vergegenwartigen,  dass  wahrend 
des  Einbalsamierungsprozesses  der  meiste  Eiter  mechanisch  weg- 
gewaschen  oder  aufgelost  oder  zur  Unkenntlichkeit  verandert  wurde 
durch  das  sogenannte  "Natronbad."  Dass  der  rechte  Psoas  in 
einem  weicheren,  halb  niissigen  Zustand  sich  befand,  als  der  Korper 
aus  der  konservierenden  Losung  genommen  wurde,  wird  bewiesen 
durch  die  Tatsache,  dass  das  Ausstopfungsmaterial  (Holzkohle  etc.) 
tief  zwischen  die  Muskeifasern  gedrungen  ist. 

Eine  andere  wichtige  Tatsache,  die  zugunsten  dieser  Ansicht 
spricht,  ist,  dass  sich  eine  Hohlung  zwischen  Muskel  und  Knochen 
der  rechten  Seite  befand,  wogegen  sich  an  der  linken  Seite  keine 
derartige  Hohlung  aumnden  liess.  Der  rechte  Muskel  muss 
deshalb  durch  irgend  einen  pathologischen  Prozess  schon  bei 
Lebzeiten  mehr  oder  weniger  von  dem  Knochen  losgelost  gewesen 
sein. 

DESCRIPTION  OF  PLATES  I-II 


Fig.  i. — A  drawing,  by  Mrs.  Cecil  M.  Firth,  of  the  mummy  of  a  priest 
of  Ammon  of  the  XXIst  Dynasty  (1000  B.C.),  showing  in  lateral  view  the 
protrusion  of  the  spine  so  commonly  seen  in  Pott's  disease. 

Fig  2. — An  untouched  photograph  of  the  anterior  aspect  of  the  mummy, 
showing  the  huge  psoas  abscess  into  which  the  pus  from  the  tuberculous  lesion 
in  the  lumbar  vertebrae  had  drained.  The  mass  was  soft  at  the  time  of 
embalming. 

PLATE   II 
(Drawings  by  Alice  M.  Ruffer) 

A. — Portion  of  the  external  surface  of  the  right  psoas  muscle  (diseased 
side)  removed  by  a  trephine. 

B. — Portion  of  the  external  surface  of  the  left  psoas  muscle  (normal  side) 
removed  by  a  trephine. 

C. — Small,  isolated  fragment  of  A. 

D. — Small,  isolated  fragment  of  B. 

E. — Cover-glass  preparation  of  the  yellow  substance  of  A.  (Leitz,  Oc.  i, 
Obj.  4.) 

F. — A  small  portion  of  E  greatly  enlarged.     (Leitz,  Oc.  i,  Obj.  1/12.) 

G. — Spores  of  mold.    The  same  diameter. 

H. — A  branched  fragment  of  fungus.    The  same  magnification. 

I. — Fungus  and  spores  more  or  less  degenerated.    The  same  magnification. 


PLATE  II 


J 


"^ 


:>* 


gfc. 


C  ( 


I 


■■*. 


REMARKS  ON  THE  HISTOLOGY  AND   PATHOLOGICAL 
ANATOMY  OF  EGYPTIAN  MUMMIES 

{Cairo  Scientific  Journal,  Vol.  IV  [January,  1910], 
No.  40) 

At  the  meeting  of  the  British  Medical  Association  in  Sheffield 
(July,  1908)  and  at  a  meeting  of  the  Cairo  Scientific  Society  (Decem- 
ber, 1908),  I  gave  a  demonstration  of  the  microscopic  structure  of 
mummified  tissues.  The  organs  examined  came  from  mummies  of 
the  priests  of  the  twentieth  dynasty,  and  had  been  given  me  by 
Professor  Elliot  Smith.  On  the  same  occasion,  and  in  a  note 
published  in  the  British  Medical  Journal  (January,  1909),  I  de- 
scribed the  method  which  I  then  used  for  the  preparation  of  such 
specimens.  My  intention  now  is  to  give  a  short  account  of  the 
results  obtained  by  this  and  similar  methods  during  the  last  year, 
but  before  doing  so,  I  wish  to  thank  Sir  Gaston  Maspero,  Professors 
Flinders  Petrie,  Elliot  Smith,  and  Keatinge,  for  providing  me  with 
the  necessary  material. 

Urinary  calculi. — Professor  Flinders  Petrie  gave  me  three  stones 
found  by  him  in  a  predynastic  skeleton,  and  which  he  had 
correctly  diagnosed  as  urinary  calculi. 

The  largest  of  these  stones  weighs  30  grammes,  and  measures 
4 . 5  centimetres  in  its  greatest  length,  and  3  centimetres  in  its 
greatest  thickness.  It  is  roughly  pear-shaped,  with  a  whitish 
smooth  surface  streaked  here  and  there  with  yellow  (incrustations 
of  fine  sand  ?). 

The  second  calculus  weighs  24  grammes,  and  measures  4  centi- 
metres in  its  greatest  length,  and  2 . 5  centimetres  in  its  greatest 
thickness.  It  is  roughly  triangular  in  shape,  and  its  surface 
resembles  that  of  the  first. 

The  third  stone  weighed  1 1 . 7  grammes  only,  and  resembled  the 
d  in  shape.     Professor  Aders  Plimmer,  of  the  Physiological 


12  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Laboratory,  University  College,  London,  kindly  analysed  it  for  me, 
and  found  its  composition  to  be  as  follows: 

Per  Cent 

Water 6.5 

Organic  Matter 34. 8 

PA 37-6 

MgO 19.7 

CaO 0.8 

Total 99-4* 

*The  insoluble  residue  gave  a  strong  murexide  reaction. 

The  centre  of  this  calculus  is  yellow,  the  periphery  irregularly 
laminated,  and  by  the  usual  methods  crystals  of  uric  acid  are  easily 
obtained.  Microscopically,  the  insoluble  residue  consists  of  organic 
debris,  staining  with  haematoxylin  (leucocytes  and  epithelial  cells 
possibly).  Anatomical  elements  or  eggs  of  parasites1  were  not 
recognisable.  The  third  calculus,  therefore  (and  probably  the 
others  also),  is  a  mixed  phosphatic  and  uric  acid  calculus,  which 
are  common  enough  in  Egypt  at  the  present  time. 

Liver  of  Ranefer.—I  received  from  Professor  Flinders  Petrie  a 
fragment  of  an  organ  found  in  the  tomb  of  Ranefer. 

It  looked  like  some  internal  organ,  or  part  of  such  an  organ, 
imbedded  in  a  large  quantity  of  mud.  The  mud  was  removed  and 
then  the  typical  arrangement  of  liver  cells  was  easily  recognised; 
the  blood  vessels,  biliary  tubes  and  connective  tissue  had 
disappeared. 

Tissues  of  predynastic  mummies. — The  fragment  of  tissue  just 
described  was  about  five  thousand  years  old  and  the  remarkable 
results  obtained  encouraged  me  to  study  microscopically  the 
prehistoric  bodies  of  the  Hearst  collection,  which  are  now  in  the 
museum  of  the  School  of  Medicine  at  Cairo,  and  which,  I  am  in- 
formed, date  from  eight  thousand  years  ago  at  least.  The  method 
used  so  far  is  fatal  to  these  tissues,  as  they  first  crumble  to  pieces 
and  then  dissolve  almost  completely.  By  using  a  macerating  fluid 
with  a  slightly  different  composition,  however,  good  sections  are 
easily  prepared,  and  these  I  intend  to  describe  fully  on  some  future 

1  Nearly  all  the  specimens  described  in  this  paper  are  now  deposited  in  the  Museum 
of  the  Government  School  of  Medicine,  Cairo. 


HISTOLOGY  AND  ANATOMY  OF  EGYPTIAN  MUMMIES      13 

occasion.  It  is  extraordinary  that  the  striation  of  the  voluntary 
muscular  fibres  and  the  nuclei  of  some  cells  should  be  perfectly 
plainly  visible  eight  thousand  years  after  death. 

Diseases  of  arteries  in  mummies  of  the  eighteenth  to  twentieth 
dynasties. — In  order  to  dissect  the  arteries,  the  following  method 
was  adopted  after  many  failures. 

The  whole  mummy  or  the  limbs  to  be  examined  are  immersed 
in  a  solution  having  the  following  composition: 

Per  Cent 

Carbonate  of  soda 2 

Formol 0.5 

Tap  water 97 

The  skin  becomes  soft  after  twenty-four  hours  or  longer  and  is 
then  stripped  off.  The  parts  are  replaced  in  the  macerating  fluid 
until  this  has  penetrated  to  the  bones,  when  the  large  arteries  are 
easily  dissected  out.  The  muscles  are  separated  from  one  another 
by  simply  running  the  finger  along  the  intermuscular  septa,  and 
nerves,  ligaments  of  joints,  cartilages,  etc.,  are  readily  seen.  The 
arteries  are  still  remarkably  elastic;  whereas  the  muscles,  though 
soft,  do  not  return  to  their  former  size  after  stretching. 

a)  The  first  aorta  examined  consists  of  a  piece  4^  inches  long, 
covered,  throughout  its  whole  length  almost,  by  a  hard  calcareous 
plate.  Small  pieces  of  this  plate  were  decalcified  in  the  following 
solution: 

Per  Cent 

Absolute  alcohol 98 

HNO3 2 

washed  several  times  in  30  per  cent  alcohol,  hardened  and  cut 
secundum  artem.  Microscopical  preparations  show  the  main 
alterations  of  calcareous  degeneration. 

b)  Another  aorta  was  taken  from  one  of  the  mummies  (eight- 
eenth to  twentieth  dynasties)  given  me  by  Professor  Flinders  Petrie. 
Its  arch  had  been  hacked  away  by  the  embalmer,  who  had  also  cut 
right  through  all  the  coats  just  above  the  bifurcation  of  the  vessel. 
The  thoracic  aorta  from  a  point  just  above  the  origin  of  the  left 
subclavian  artery,  and  the  whole  of  the  abdominal  artery,  were 
intact  and  easily  removed.  The  internal  coat  is  studded  with  small 
calcareous  patches  and  the  two  largest,  each  the  size  of  a  shilling, 


14  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

are  situated  just  above  the  bifurcation.  The  left  subclavian  artery, 
at  a  point  just  above  its  origin,  is  almost  blocked  by  a  raised,  ragged 
calcareous  excrescence,  as  large  as  a  threepenny  bit  (calcified 
atheromatous  ulcer).  Small  atheromatous  patches,  not  calcified, 
are  scattered  through  the  whole  length  of  the  aorta,  and  these, 
owing  to  the  dark  coloration  of  the  tissues,  are  more  easily  felt 
than  seen. 

The  common  carotid  arteries  show  small  patches  of  atheroma, 
but  the  most  marked  changes  are  found  in  the  pelvic  arteries  and 
in  those  of  the  lower  limbs. 

The  common  iliac  arteries  are  studded  with  small  patches  of 
atheroma  and  calcareous  degeneration.  The  other  arteries  of  the 
pelvis  are  converted  by  calcification  into  rigid,  "bony"  tubes,  down 
to  their  minute  ramifications.  So  stiff  and  brittle  are  they  that  it 
was  impossible  to  dissect  them  out  entire,  as  in  spite  of  every 
possible  care  they  were  invariably  broken.  The  minute  intra- 
muscular arteries  were  easily  felt  on  triturating  the  muscles  under 
the  fingers. 

Both  armsand  the  legs  (about  6  inches  below  Poupart's  ligament) 
had  been  lost,  but  on  the  right  side  the  common  femoral  and  the 
profunda  were  dissected  out.  Both  are  converted  into  rigid 
calcareous  tubes. 

It  is  to  be  noted  that  as  far  as  could  be  made  out  from  the 
examination  of  the  cartilages  of  the  ribs  the  mummy  was  not  that 
of  a  very  old  person. 

c)  A  Greek  mummy  given  me  by  Sir  Gaston  Maspero  also  shows 
atheromatous  patches  in  the  aorta  and  brachial  arteries.  From  the 
examination  of  the  cartilages,  etc.,  I  concluded  at  the  time  that  the 
man  was  not  above  fifty  years  old  at  the  time  of  death. 

d)  I  had  an  opportunity  also  of  examining  the  legs  of  an  old 
woman  of  the  twentieth  dynasty.  The  body  has  been  very  care- 
fully embalmed,  and  all  the  muscles  and  most  of  the  arteries 
removed,  sand  and  linen  filling  their  places.  The  posterior  tibial 
artery,  however,  was  dissected  out  and  found  ossified  from  end 
to  end. 

Arterial  disease,  therefore,  was  of  frequent  occurrence  among 
Egyptians  of  old,  and  indeed  temporal  arteries  of  mummies  in 


HISTOLOGY  AND  ANATOMY  OF  EGYPTIAN  MUMMIES      15 

various  museums  are  as  tortuous  as  they  are  at  the  present  day,  even 
in  people  who  died  when  comparatively  young. 

I  may  add  that  very  interesting  microscopical  preparations 
were  obtained  from  all  arteries  which  had  been  isolated. 

Lesions  of  lungs. — Owing  to  the  shrivelled  state  of  the  lungs, 
naked-eye  evidence  of  pulmonary  disease  is  not  easily  obtainable. 
With  the  microscope,  however,  pathological  changes  were  detected 
in  the  lungs  of  several  mummies. 

a)  The  lungs  of  one  mummy  (twentieth  dynasty)  present  all  the 
signs  of  diffuse  anthracosis,  the  alveoli  and  the  alveolar  interspaces 
containing  an  enormous  quantity  of  jet-black  or  dark  yellow  mate- 
rial (soot).  Some  of  the  alveoli  are  so  full  of  this  black  stuff  that 
at  first  I  thought  that  an  emulsion  of  finely  divided  charcoal  had  been 
poured  down  the  trachea  into  the  bronchi.  I  realized  my  mistake 
when  I  found  that  the  material  had  penetrated  into  the  depths  of 
the  tissues  and  that  there  were  evident  signs  of  inflammation  in  the 
alveoli.  This  condition  of  things  is  frequently  found  at  the  present 
time,  among  miners,  cooks,  and  persons  living  in  a  smoky  atmos- 
phere, and  I  have  no  doubt  that  this  person  was  engaged  in  some 
work  necessitating  his  presence  in  smoke-laden  air. 

b)  The  two  lungs  (twentieth  dynasty)  to  be  described  now 
present  nothing  abnormal  to  the  naked  eye,  but  nevertheless 
I  expected  to  find  pathological  change  in  them,  as  small  pieces  had 
been  left  behind  and  were  sticking  to  the  pleura.  I  suspected  that 
pathological  adhesions  had  probably  existed  during  life. 

Under  the  microscope,  all  the  alveoli  are  seen  to  be  crammed 
with  cells,  some  of  the  characteristics  of  which,  e.g.,  nuclei,  can  be 
recognized  still. 

No  micro-organisms  are  visible  except  in  one  place  where 
numerous  micrococci  are  packed  in  an  alveolus.  Although  they 
still  stain  by  Gram's  method,  I  am  unable  to  say  to  what  species  of 
micrococci  they  belong.  In  spite  of  the  almost  total  absence  of 
micro-organisms  and  judging  from  the  pathological  appearances 
only,  I  do  not  hesitate  in  making  the  diagnosis  of  pneumonia,  which 
had  advanced  to  the  stage  of  hepatisation. 

c)  This  lung  came  from  a  mummy  dating  from  the  Greek 
period.     There  is  nothing  abnormal  in  the  apex  and  upper  half  of 


16  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

this  organ,  which  became  flexible  after  softening  in  the  usual 
manner,  and  floats  in  60  per  cent  of  alcohol.  On  the  contrary,  the 
lower  part  immediately  sinks  in  that  fluid.  Moreover,  on  section, 
the  upper  portion  of  the  organ  is  spongy  looking,  the  lower  part 
shows*  a  dense,  almost  solid  section,  much  resembling  muscle.  Con- 
solidation of  the  lower  lobe,  therefore,  had  evidently  taken  place. 

Microscopic  examination  of  the  upper  part  of  the  lung  shows 
here  and  there  patches  of  inflammation,  and  a  few  short  bacilli, 
with  rounded  edges,  scattered  in  groups  through  the  tissue. 

The  alveoli  of  the  lower  part  of  the  lung  are  full  of  exudation  in 
which  very  few  anatomical  elements  are  plainly  recognisable,  and 
an  enormous  number  of  the  bacilli  just  mentioned. 

The  liver  of  the  same  mummy  was  also  examined.  The  inter- 
lobular connective  tissue  is  much  denser  than  usual,  and  strands  of 
the  tissue  run  between  the  liver  cells.  The  interesting  point,  how- 
ever, is  the  large  number  of  the  same  bacilli  in  the  tissues  and 
in  blood  vessels. 

These  bacilli  stain  well  with  haematoxylin,1  methylene  blue, 
fuchsin,  but  not  with  Gram's  method.  They  are  ovoid  in  form 
about  the  size  of  plague  bacilli,  though  plumper,  and,  except  in  a 
few  cases,  without  a  clear  interspace  between  their  extremities. 
A  careful  examination  of  numerous  preparations  left  me  with  the 
impression  that  they  had  certainly  been  present  during  life  and  that 
they  were  pathogenic.  Indeed,  had  a  bubo  been  found  I  should 
have  diagnosed  the  case  as  one  of  plague.  At  present,  with  the 
very  scanty  knowledge  of  the  changes  undergone  by  micro- 
organisms in  mummified  tissue,  it  will  be  best  not  to  make  any 
definite  diagnosis. 

It  is  clear,  however,  that  micro-organisms  retain  their  characters 
unaltered  in  mummified  tissue.  I  have  found  in  organs  that  had 
evidently  undergone  putrefaction  Gram-positive  and  Gram-negative 
micro-organisms,  and  others  the  spores  of  which  gave  all  the  typical 
staining  reactions.  Considering  that  the  nuclei  of  some  mummified 
or  simply  dried  tissue  stain  characteristically,  this  result  was  not 
unexpected. 

1 1  use  Bohmer's  haematoxylin,  not  less  than  one  year  old.  I  do  not  know  why 
this  simple  and  excellent  stain  is  not  used  more  extensively  for  micro-organisms. 


HISTOLOGY  AND  ANATOMY  OF  EGYPTIAN  MUMMIES      17 

Renal  lesions. — (a)  The  kidneys  of  one  mummy  given  me  by 
Professor  Flinders  Petrie  had  not  been  removed  by  the  embalmers. 
The  right  kidney  presents  nothing  abnormal,  but  the  left  measures 
only  4.5  centimetres  in  length,  3.5  centimetres  in  breadth,  and 
weighs  3  grammes. 

Microscopically,  there  are  no  signs  of  inflammation  except  for 
some  slight  thickening  of  the  capsule  and  of  the  connective  tissue 
in  some  parts  of  the  medulla.  I  am  not  satisfied  that  where  the 
connective  tissue  looks  denser,  this  appearance  is  due  to  a  pathologi- 
cal change,  and  not  to  an  unequal  expansion  of  the  organ  in  the 
softening  fluid.  Any  cirrhosis  would  be  easy  of  detection,  for  the 
connective  tissue  stains  well,  the  epithelium  is  remarkably  well 
preserved,  and  there  is  no  desquamation  whatever.  The  atrophy 
was  congenital,  therefore,  a  condition  not  infrequently  found  at 
the  present  day. 

b)  The  kidneys  of  another  mummy  of  the  eighteenth  to  twen- 
tieth dynasties  (1580-1050  B.C.)  contained  multiple  abscesses  with 
well-staining  bacilli,  and  other  lesions,  which  so  far  I  have  not  yet 
diagnosed.  The  bacilli  are  found  in  the  abscesses  and  their  im- 
mediate neighbourhood,  but  nowhere  else.  They  are  short, 
straight  bacilli,  which  take  haematoxylin  and  basic  aniline  dyes 
readily,  but  not  Gram's  stain.  They  greatly  resemble  the  bacillus 
coli,  as  seen  at  the  present  day. 

c)  In  the  kidneys  of  two  mummies  of  the  twentieth  dynasty1 
I  have  demonstrated  a  large  number  of  calcified  eggs  of  Bilharzia 
haematobia  situated  for  the  most  part  among  the  straight  tubules. 
These  kidneys  had  other  lesions  as  well,  which,  owing  to  the 
shrunken  state  of  the  organs,  I  am  unable  to  define  as  yet. 

Renal  disease,  therefore,  was  not  infrequent  among  Egyptians 
living  over  three  thousand  years  ago. 

Conclusion.— The  only  object  of  this  paper  has  been  to  draw 
attention  to  the  possibilities  opened  up  by  this  method  of  study, 
with  the  hope  of  encouraging  others  to  take  up  the  same  subject. 
I  have  purposely  avoided  giving  histological  details,  as  I  hope  to 
publish  these  and  other  results  fully  at  some  not  very  distant  date. 

1  Sec  also  British  Medical  Journal,  January,  1910,  p.  16. 


NOTE  ON  THE  PRESENCE  OF  "BILHARZIA  HAEMATO- 

BIA"  IN  EGYPTIAN  MUMMIES  OF  THE  TWENTIETH 

DYNASTY  (1250-1000  B.C.) 

{British  Medical  Journal,  January  i,  1910) 

In  a  previous  note  published  in  this  Journal,  I  described  a 
process  by  which  mummified  tissues  could  be  prepared  for  histologi- 
cal examination.  I  ventured  to  predict  that  it  was  highly  probable 
that,  by  this  method,  one  would  be  able  to  recognize  pathological 
changes,  such  as  cirrhosis,  cancer,  etc. 

Thanks  to  the  kindness  of  Professor  Elliot  Smith,  Professor 
Flinders  Petrie,  and  Professor  Keatinge,  I  have  obtained  several 
organs  from  mummies  of  the  eighteenth  to  the  twentieth  dynasty, 
and  I  may  state  at  once  that  such  diseases  as  atheroma,  pneumonia, 
renal  abscesses,  and  cirrhosis  of  the  liver  are  plainly  recognizable. 
In  the  renal  abscesses  and  in  other  lesions  I  have  stained  micro- 
organisms with  methylene  blue,  fuchsin,  haematoxylin,  and  even 
by  Gram's  method. 

At  the  present  time  there  is  perhaps  no  disease  more  important 
to  Egypt  than  that  caused  by  the  Bilharzia  haematobia.  So  far 
no  evidence  has  been  produced  to  show  how  long  it  has  existed  in 
this  country,  although  medical  papyri  contain  prescriptions  against 
one  of  its  most  prominent  symptoms — namely,  haematuria.  The 
lesions  of  this  disease  are  best  seen  in  the  bladder  and  rectum,  but 
unfortunately  these  are  just  the  two  mummified  organs  which  1  have 
not  been  able  to  obtain  so  far.  Nevertheless,  in  the  kidneys  of  two 
mummies  of  the  twentieth  dynasty,  I  have  demonstrated  in  micro- 
scopic sections  a  large  number  of  calcified  eggs  of  Bilharzia  haema- 
tobia, situated,  for  the  most  part,  among  the  straight  tubules. 
Although  calcified,  these  eggs  are  easily  recognizable  and  cannot 
be  mistaken  for  anything  else.  I  may  add  that  I  showed  some  of 
my  sections  to  Professors  Looss  and  Ferguson,  whose  paramount 
authority  on  such  a  subject  cannot  be  disputed,  and  both  confirmed 
my  diagnosis. 


"BILHARZIA  HAEMATOBIA"  IN  EGYPTIAN  MUMMIES       19 

I  have  examined  microscopically  the  kidneys  of  six  mummies. 
The  kidneys  of  two  were  apparently  healthy;  the  left  kidney  of 
another  was  congenitally  atrophied;  those  of  the  fourth  contained 
multiple  abscesses  with  well-staining  bacteria  and  other  lesions, 
which  so  far  I  have  not  diagnosed;  those  of  the  fifth  and  sixth 
showed  Bilharzia  eggs,  and  the  latter  had  other  lesions  as  well, 
which,  owing  to  the  shrunken  state  of  the  organ,  I  am  unable  to 
define  accurately  as  yet. 


ON  ARTERIAL  LESIONS  FOUND  IN  EGYPTIAN 
MUMMIES  (1580  B.C.— 525  A.D.) 

{Journal  of  Pathology  and  Bacteriology,  Vol.  XV  [191 1]) 

The  mummies  examined  came  from  the  XVIIIth-XXVIIth 
Dynasties  (1580  B.c-525  a.d.),  and  from  the  time  of  the  Persian  con- 
quest (500  B.C.).  I  also  dissected  a  Greek1  and  a  Coptic  mummy, 
the  latter  dating  from  the  fifth  or  sixth  century  after  Christ. 

The  investigations  therefore  range  over  a  period  of  two  thousand 
years — namely,  from  1580  B.C.  to  525  a.d. 

I  take  this  opportunity  of  thanking  Sir  Gaston  Maspero,  Profes- 
sor Flinders  Petrie,  Professor  Elliot  Smith,  Dr.  Derry,  and  Dr. 
Keatinge  for  help.  To  the  last  gentleman  my  thanks  are  specially 
due  for  giving  me  a  number  of  arms  and  legs  from  broken-up  mum- 
mies of  the  XXIst  Dynasty  (1090-945  B.C.).  These  limbs  were  of 
no  possible  use  as  museum  specimens,  and  I  had  no  hesitation,  there- 
fore, in  dissecting  them.  Most  of  the  preparations  came  from 
them.2 

DIFFICULTIES   OF   THE   INQUIRY 

The  chief  difficulty  consisted  in  the  extensive  mutilations  made 
during  the  process  of  embalming.  Dr.  Elliot  Smith  has  shown  that 
at  the  time  of  the  XXIst  Dynasty,  the  embalmers  removed  the 
whole  of  the  viscera,  the  aorta,  and  most  of  the  muscles  of  the  body. 
The  body  cavity  and  the  holes  left  in  the  limbs  after  removal  of  the 
muscles  are  found  filled  with  mud,  sand  or  rags,  or  all  three. 

The  sole  of  the  foot  is  packed  with  sawdust  mixed  with  some 
"resinous"  material.     The  muscles  and  big  blood  vessels  of  the 

1  This  mummy  was  given  me  as  coming  from  the  Greek  period.  Judging  from  the 
way  it  was  embalmed,  I  am  of  opinion  that  it  really  dated  from  the  XXIst  and  certainly 
not  later  than  the  XXIId  Dynasty. 

■  The  only  papers  I  know  on  the  subject  are:  (a)  Shattock,  "Microscopic  Sections 
of  the  Aorta  of  King  Merneptah,"  Lancet,  London,  January  30,  1909;  and  (b) 
Armand  Ruffer,  "  Remarks  on  the  Histology  and  Pathological  Anatomy  of  Egyptian 
Mummies,"  Cairo  Scientific  Journal,  Vol.  IV,  January,  1910.  Some  of  my  pathological 
sections  were  shown  at  a  meeting  of  the  Cairo  Scientific  Society  in  December,  190S. 


ARTERIAL  LESIONS  IN  EGYPTIAN  MUMMIES  21 

neck  are  also  gone,  the  larynx  is  either  pushed  upwards  or  has  been 
removed,  and  the  neck  is  filled  with  mud  or  rags.  The  cheeks  are 
filled  out  with  a  fatty  material  mixed  with  sand  and  sawdust,  and 
the  brain  removed.  It  is  only  by  accident,  therefore,  that  the 
whole  or  a  portion  of  the  aorta,  or  one  of  the  large  arteries  is  left 
behind.  Fortunately  for  our  purpose,  one  artery,  namely  the 
posterior  peroneal,  owing  to  its  deep  situation,  often  escaped 
the  embalmer's  knife.  In  a  few  cases  also,  when  the  embalm- 
ers  had  evidently  scamped  their  work,  the  arm  or  leg  was 
untouched. 

After  the  removal  of  the  foreign  material,  and  when  the  limb 
is  plunged  in  the  softening  solution,  the  walls  of  the  cavity  thus  left 
are  often  found  lined  with  a  hard  black  material,  not  easily  removed 
by  water  or  a  weakly  alkaline  solution.  It  must  be  taken  away 
mechanically,  and  this  often  proves  a  very  tedious  process.  When 
left  standing  in  the  hot  and  damp  summer  atmosphere  of  our 
laboratory,  a  brown  gummy  sticky  fluid  exudes  out  of  this  material. 
The  same  gummy  substance  is  also  found  in  bandages  kept  under 
similar  conditions.  I  hope  shortly  to  have  some  chemical  evidence 
as  to  its  nature. 

The  limbs  of  such  mummies  of  the  XXVIIth  Dynasty  as  I  exam- 
ined were  intact,  but  the  body  cavity  had  been  almost  cleaned  out. 
The  thoracic  cavity  contained  an  enormous  quantity  of  jet  black 
material  showing  a  glistening  surface,  which  I  should  certainly  never 
have  suspected  of  containing  any  tissue.  In  one  case,  however,  a 
lump  of  this  substance,  which  to  the  naked  eye  appeared  to  contain 
no  tissue  whatever,  was  placed  in  running  hot  water.  The  black 
substance  slowly  dissolved  out,  and  then  a  small  piece  of  aorta 
appeared,  which,  after  long  washing,  showed  exquisite  calcareous 
patches.  Mr.  Lucas,  who  has  chemically  examined  some  of  the 
material  found  in  the  mummies,  will  doubtless,  later  on,  give  the 
result  of  his  researches.  Suffice  it  to  say  that  the  black  shiny 
material  is  not  bitumen.  Indeed,  it  is  a  striking  fact  that  up  to  the 
present  I  have  never  found  bitumen  in  any  mummy,  even  in  those 
of  the  Ptolemaic  period. 

The  Coptic  mummy  had  apparently  been  simply  dried,  and 
there  was  no  evidence  of  its  having  been  embalmed  in  any  way. 


22  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

METHOD   OF   ISOLATING   THE   ARTERIES 

The  mud,  sand,  bandages,  and  gummy  material  are  first  picked 
out  with  forceps,  or  slowly  scraped  away;  a  most  unpleasant  task, 
as  the  dust  floating  in  thick  clouds  about  the  room  is  most  irritating 
to  the  lungs.  The  "packing"  does  not  appear  to  contain  patho- 
genic microbes,  as,  in  spite  of  numerous  cuts  and  scratches,  no 
inflammation  followed. 

The  limbs  or  trunk  are  thoroughly  washed,  and  deep  incisions 
are  made  into  the  skin  wherever  necessary.  The  parts  to  be  exam- 
ined are  then  placed  in  a  solution  containing  carbonate  of  soda 
i  per  cent  and  formol  0.5  to  1  per  cent,  and  soaked  for  twenty-four 
to  forty-eight  hours,  when  the  skin  can  be  taken  off  as  a  rule. 
After  a  few  days  of  this  treatment,  the  remaining  muscles,  fasciae, 
etc.,  are  soft  enough  to  allow  the  arteries  to  be  dissected  out. 
Unfortunately,  the  condition  of  the  tissues  is  very  variable,  part  of 
one  limb,  for  instance,  softening  quickly,  the  remainder  more  slowly, 
In  some  cases,  without  any  apparent  reason,  the  muscles  remain  as 
hard  as  stone. 

The  arteries,  especially  the  larger  ones,  such  as  the  aorta,  fem- 
oral, brachial,  etc.,  are  completely  flattened  out,  looking  as  if  they 
had  been  well  ironed,  and  are  therefore  often  difficult  to  find.  If 
they  have  undergone  marked  fibroid  or  calcareous  changes,  the 
lumen  may  be  patent  and  the  vessel  easily  seen. 

The  arteries  are  dissected  out  and  placed  in  a  fresh  solution  of 
the  aforementioned  fluid  for  twenty-four  hours.  All  adhering  con- 
nective tissue  is  now  removed,  and  the  vessels  are  plunged  into 
glycerine  to  which  a  few  drops  of  formol  have  been  added.  This 
solution  must  be  changed  two  or  three  times  in  the  course  of  the 
next  few  weeks,  as  some  coloring  matter  invariably  dissolves  out. 

For  microscopic  examination  small  pieces  of  a  calcified  artery 
are  placed  in  alcohol  containing  nitric  acid,  or  better  into  Marchi's 
solution.1  After  twenty-four  hours  or  longer  the  decalcified  piece 
is  washed  in  water  for  some  hours,  hardened,  embedded  in  paraffin, 
and  cut  in  the  usual  manner. 

1 1  have  given  up  alcohol  and  nitric  acid,  as  Marchi's  solution  gives  much  better 
results. 


ARTERIAL  LESIONS  IN  EGYPTIAN  MUMMIES  23 

Fibrous  pieces  were  hardened  in  alcohol  in  the  usual  way.  It  is 
very  difficult  to  know,  however,  whether  a  given  artery  does  or  does 
not  contain  small  calcareous  patches,  so  that  for  practical  purposes 
it  is  always  better  to  decalcify  first.  Marchi's  solution  does  no 
harm,  and  by  adopting  this  process  much  time  will  be  saved. 

DESCRIPTION  OF  ARTERIES  EXAMINED 

1.  Aorta  (XX  1st  Dynasty)  consists  of  a  piece  4!  inches  long,  covered  almost 
throughout  its  whole  length  by  a  hard  calcareous  plate. 

2.  Aorta  (XVIIIth-XXth  Dynasties). — The  arch  had  been  hacked  away 
by  the  embalmer,  who  had  also  cut  right  through  all  the  coats  just  above  the 
bifurcation  of  the  vessel.  The  thoracic  aorta  from  a  point  just  above  the  origin 
of  the  left  subclavian  artery  and  the  whole  of  the  abdominal  aorta  were  intact 
and  easily  removed.  The  internal  coat  is  studded  with  small  calcareous 
patches,  and  the  two  largest,  each  nearly  the  size  of  a  shilling,  are  situated 
just  above  the  bifurcation.  The  left  subclavian  artery  at  a  point  just  above 
its  origin  is  almost  blocked  by  a  raised,  ragged,  calcareous  excrescence,  as 
large  as  a  threepenny-bit  (calcined  atheromatous  ulcer).  Small  atheromatous 
patches,  not  calcified,  are  scattered  through  the  whole  length  of  the  aorta,  and 
these,  owing  to  the  dark  coloration  of  the  tissues,  are  more  easily  felt  than 
seen. 

The  common  carotid  arteries  show  small  patches  of  atheroma,  but  the  most 
marked  changes  are  found  in  the  pelvic  arteries  and  in  those  of  the  lower 
limbs. 

The  common  iliac  arteries  are  studded  with  small  patches  of  atheroma  and 
calcareous  degeneration.  The  other  arteries  of  the  pelvis  are  converted  by 
calcification  into  rigid  "bony"  tubes,  down  to  their  minute  ramifications.  So 
stiff  and  brittle  are  they  that  it  was  impossible  to  dissect  them  out  entire, 
and  in  spite  of  every  possible  care  they  were  invariably  broken.  The  minute 
intramuscular  arteries  were  easily  felt  on  triturating  the  muscles  under  the 
fingers. 

Both  arms  and  the  legs  (about  6  inches  below  Poupart's  ligament)  had 
been  lost,  but  on  the  right  side  the  common  femoral  and  profunda  were  dis- 
sected out.    Both  were  converted  into  rigid  calcareous  tubes. 

It  is  to  be  noted  that,  as  far  as  could  be  made  out  from  the  examination 
of  the  cartilages  of  the  ribs,  the  mummy  was  not  that  of  a  very  old  person. 

3.  Atheromatous  patches  in  the  aorta  and  brachial  arteries  in  a  Greek  mummy. 
— From  the  examination  of  the  cartilages,  etc.,  I  concluded  at  the  time  that  the 
man  was  not  above  50  years  old  at  the  time  of  death. 

4.  Piece  of  thoracic  aorta  (XXVIIth  Dynasty),  altogether  4^  inches  long. 
It  contains  seven  calcareous  patches,  two  of  which  are  figured  in  Plate  III, 
Fig.  .3.     No  other  lesion. 


24  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

5.  Aorta  from  a  Coptic  mummy. — Small  hard  calcareous  patches  scattered 
throughout  its  length.  The  two  largest  are  just  above  the  bifurcation  and  are 
almost  the  size  of  a  sixpenny-piece. 

6.  and  7.  Pieces  of  two  aortae,  thoracic  {XXI st  Dynasty). — No  lesions. 

8.  Posterior  tibial  artery. — From  a  woman  of  the  XXIst  Dynasty,  calcified 
from  end  to  end. 

9.  Posterior  peroneal  artery. — A  piece  about  4  inches  long.  Artery  stiff, 
lumen  patent;  evidently  calcareous  in  places.  After  soaking,  artery  still  very 
stiff;  calcareous  patches  visible  from  outside.  On  opening,  internal  and  middle 
coats  almost  completely  calcified  in  places.  In  other  places,  vessel  studded 
with  minute  calcareous  nodules  projecting  into  the  lumen  of  the  tube,  hardly 
any  healthy  tissue  being  left  between  nodules. 

10.  Anterior  tibial  artery. — Apparently  healthy,  though  lumen  patent. 
On  careful  examination  with  lens,  small  points  about  the  size  of  a  pin's  head> 
of  a  darkish  brown  color.  Microscopically  these  points  were  found  to  be 
foci  of  disease. 

11.  Posterior  tibial  artery. — One  piece  about  6  inches  long.  This  is  com- 
pletely calcified,  the  whole  being  converted  into  a  rigid  calcareous  tube. 

12.  Posterior  peroneal. — Apparently  quite  normal.  The  contrast  between 
this  smooth,  highly  flexible  artery  and  the  diseased  vessels  is  most  striking. 

13.  Posterior  peroneal  artery. — Quite  soft  and  flexible,  but  here  and  there 
small  highly  colored  brown  patches  project  into  the  lumen. 

14.  A  small  piece  of  anterior  tibial  artery  and  dorsalis  pedis. — Walls  not 
markedly  thickened,  but  distinctly  nodular,  with  dark  brown  small  nodules 
projecting  into  lumen. 

15.  Femoral,  profunda,  and  branches. — Very  tortuous  and  almost  com- 
pletely calcified. 

16.  Posterior  tibial  and  branches. — Almost  completely  calcified  from  end 
to  end. 

17.  A  piece  of  artery  found  mixed  with  the  packing  of  the  leg. — Apparently 
quite  normal. 

18.  Part  of  posterior  tibial  and  peroneal  artery. — Stiff,  but  no  other  changes 
to  the  naked  eye. 

19.  Piece  of  ulnar  artery,  about  3  inches  long. — Lumen  patent  and  artery 
stiff  after  soaking  and  being  plunged  in  glycerine  for  weeks.  It  has  a  curiously 
mottled,  brown  and  white  appearance.  On  cutting  sections,  fairly  extensive 
calcification  was  discovered. 

20.  Several  small  pieces  of  a  brachial  artery.— In  glycerine  it  becomes 
beautifully  transparent,  light  yellow  in  color,  but  in  spite  of  several  weeks' 
soaking  the  longitudinal  folds  do  not  disappear.  From  the  outside  small 
brownish  spots  are  seen  studding  it.  On  opening,  these  spots  are  seen  to  be 
small  nodules  projecting  into  the  lumen.  Some  have  a  whitish  centre  with  a 
brown  irregular  margin. 


ARTERIAL  LESIONS  IN  EGYPTIAN  MUMMIES  25 

21.  Ulnar  artery. — Apparently  quite  normal. 

22.  Part  of  palmar  arch,  soft  and  flexible. — Small  brownish  patches  in  first 
digital  branch. 

23.  Ulnar  artery. — Apparently  normal. 

24.  Brachial,  ulnar,  and  two  inches  of  radial  arteries. — Ulnar  and  radial 
almost  completely  ossified.  Brachial  studded  throughout  its  length  with 
brownish  prominent  patches  projecting  into  lumen  of  the  tube.  These  are 
mostly  quite  soft,  but  the  centre  of  some  is  undoubtedly  calcified.  The  whole 
artery  is  markedly  thicker  than  it  should  be. 

N.B. — When  not  otherwise  stated  the  mummies  belonged  to  the  XXIst 
Dynasty. 

The  results  noted  may  be  summed  up  as  follows: 

1.  Complete  or  incomplete  calcification. — There  is  no  difficulty  in 
recognising  completely  or  partially  calcified  arteries.  Even  before 
they  are  placed  in  the  softening  solution,  or  at  any  rate  shortly 
afterwards,  their  hard,  "osseous"  structure  is  manifest.  Arteries, 
such  as  are  depicted  in  Plate  III,  Fig.  1,  are  as  rigid  as  calcified 
arteries  of  the  present  day. 

When  slit  up,  even  with  the  finest  scissors  and  the  greatest  care, 
the  calcareous  middle  and  inner  coats  have  a  tendency  to  detach 
themselves  from  the  adventitia,  and  to  break  up  into  small  brown 
roughly  rectangular  plates  (see  Plate  III,  Fig.  2).  In  this  picture 
a  small  artery  just  branching  off  shows  well-marked  calcareous 
change. 

After  decalcification  in  picric  acid  and  staining,  microscopical 
sections  of  such  arteries  are  most  interesting  and  will  be  best  under- 
stood by  examining  Plate  IV,  Fig.  9  This  shows,  under  a  low 
power,  a  decalcified  posterior  peroneal  artery,  stained  by  Van 
Gieson's  method,  from  a  mummy  of  the  XXIst  Dynasty.  The 
section  is  perhaps  not  quite  satisfactory,  in  so  far  that,  nearly  the 
whole  of  the  artery  being  diseased,  it  is  difficult  to  find  points  of 
comparison  between  healthy  and  calcareous  tissue.  Only  shreds  of 
endothelium  and  fenestrated  membrane,  for  instance,  are  left  at 
a,  ai,  and  02. 

The  point  of  interest  is  that  the  muscular  coat  has  been  changed 
almost  wholly  by  calcification,  following  on  degeneration  of  the 
muscle  fibre,  into  a  magma  of  no  particular  structure.  The  disease 
clearly  did  not  begin  in  one  spot,  but  in  several  foci  which  coalesced, 


26  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

as  at  b,  for  example.  When  the  section  is  stained  with  haematoxy- 
lin  alone  the  calcified  parts  are  coloured  so  black  that  hardly  any 
structure  is  recognisable.  Plate  IV,  Fig.  10,  represents  part  of  a 
calcified  ulnar  artery  under  a  high  power  (same  stain  as  previously). 
In  this  section  the  muscular  fibres  at  a  have  been  completely 
destroyed  by  calcification,  so  that  no  structure  is  recognisable.  At 
b,  on  the  other  hand,  the  annular  fibres  are  still  indicated,  though 
somewhat  vaguely,  whereas  at  c  they  are  plainly  visible.  To  the 
naked  eye  this  artery  appeared  to  be  completely  calcified. 

Partial  calcification  was  best  seen  in  the  aorta,  and  is  well  illus- 
trated by  Figs.  3  and  4  in  Plate  III.  Here  we  see  calcareous  patches 
in  two  aortae.  Fig.  3  represents  part  of  the  abdominal  aorta  of 
a  mummy  of  the  XXVIIth  Dynasty,  and  Fig.  4  a  piece  of  a  thoracic 
aorta  dating  from  the  same  dynasty.  The  flattened  vessel  did  not 
open  out  again,  in  spite  of  long  soaking  in  glycerine,  but  remained 
angular. 

The  calcareous  patches  are  quite  obvious,  and  it  is  unnecessary 
to  describe  them  any  further.  In  the  aorta  depicted  in  Plate  III, 
Fig.  3,  they  projected  to  a  considerable  extent  into  the  lumen  of 
the  tube. 

Such  aortae  are  not  good  objects  for  microscopical  examination, 
because,  however  careful  the  decalcification,  the  calcified  part 
almost  invariably  falls  off.  In  the  calcified  part  nothing  can  be 
seen  except  a  few  shreds  of  muscular  tissue  lying  between  oval  or 
round  masses  of  calcified  material  staining  almost  black  with 
haematoxylin. 

In  the  coats  of  the  aorta,  beneath  the  wholly  calcified  parts,  one 
sees  almost  normal  muscular  fibres,  but  here  and  there  are  small 
round  darkly  staining  masses  such  as  have  been  already  described 
in  the  posterior  peroneal  and  radial  arteries.  These  are  manifestly 
patches  of  incipient  calcareous  degeneration. 

An  interesting  point  is  that  very  often  the  disease  seems  to  pick 
(see,  for  instance,  Plate  III,  Fig.  4)  just  the  point  of  origin  of  the 
smaller  arteries. 

On  examining  carefully  the  inner  lining  of  such  an  artery,  one 
often  sees  small  brownish  nodules.  These,  however,  are  much  more 
evident  in  the  smaller  arteries  and  will  be  described  more  fully  here- 


ARTERIAL  LESIONS  IN  EGYPTIAN  MUMMIES  27 

after.  Indeed,  in  the  larger  vessels  they  are  much  more  easily  felt 
than  seen.1 

In  one  subclavian  artery  of  the  XVIIIth-XXth  Dynasties  the 
lumen  of  the  artery  near  its  origin  was  almost  blocked  by  a  ragged 
calcareous  excrescence,  depicted  in  Plate  III,  Fig.  5.  There  can  be 
no  doubt  that  this  person  narrowly  escaped  embolism. 

2.  Partial  calcification  and  atheroma. — When  an  artery  like  the 
femoral  or  brachial  is  partly  or  completely  calcified,  there  can 
be  no  difficulty  in  recognising  such  a  lesion.  The  case  is  differ- 
ent, however,  when  the  lesions  are  slight,  as  they  are  com- 
pletely obscured  by  the  colouring  matter  and  the  opacity  of  the 
tissue. 

Good  results  can  be  obtained,  however,  by  soaking  pieces  in 
glycerine  to  which  a  few  drops  of  formol  have  been  added,  when, 
after  a  few  days,  the  tissues  become  transparent.  In  many  cases, 
even  before  the  artery  is  opened,  one  sees  through  the  coat  (Plate 
III,  Fig.  8)  small  dark  brown  patches,  which  are  then  also  felt  easily. 
When  the  artery  is  opened  these  patches  are  seen  to  protrude  into 
the  lumen  (Plate  III,  Figs.  6  and  7),  and  sometimes  they  have  a 
hard  white  centre  (Plate  III,  Fig.  6) ,  which  is  manifestly  calcareous 
to  the  touch. 

In  pieces  of  such  an  artery,  hardened  and  stained  in  the  usual 
way,  these  patches  are  found  to  be  just  under  the  fenestrated  mem- 
brane, which  is  easily  recognised  at  one  or  both  edges  of  the  prepara- 
tion (Plate  V,  Figs.  116  and  1 2) .  The  inner  membrane  of  the  artery 
is  often  intact;  sometimes  the  lesion  has  evidently  broken  through 
it  (Plate  V,  Fig.  12). 

The  lesion,  therefore,  is  in  the  middle  coat  of  the  artery,  the 
muscle  fibres  of  which  are  transformed  into  dark  deeply  staining 
strands,  which  have  evidently  undergone  some  very  marked 
degeneration  (Plate  V,  Fig.  nd,  e,f,  and  Fig.  12). 

Very  often  nothing  more  can  be  seen,  and  there  is  no  sign  of 
emigration  of  leucocytes  in  or  around  the  diseased  tissue. 

1  In  this  connection  it  must  not  be  forgotten  that,  for  some  unexplained  reason, 
air  bubbles  arc  often  present  between  the  middle  and  inner  coat.  These  cause  the 
inner  coat  to  bulge  outwards,  causing  an  appearance  as  if  the  aorta  were  studded  with 
small  atheromatous  patches.  A  little  pressure  at  once  causes  them  to  flatten  out  and 
di  appear. 


28  STUDIES  IN  THE  PALEOPATHOLOGY  OF  EGYPT 

In  some  arteries,  however,  I  have  seen  around  the  degenerated 
patch  small  irregular  bodies,  which  may  or  may  not  be  leucocytes 
(Plate  V,  Fig.  13a). 

I  do  not  attach  much  importance  to  this  absence  of  leucocytes, 
as  I  know  from  experience  that  leucocytes  are  hardly  ever  found  in 
mummies,  even  in  such  tissues  and  lesions  where  we  know  that  they 
must  have  been  present  in  considerable  numbers  during  life.  Why 
this  should  be  the  case  need  not  be  discussed  here. 

I  have  already  drawn  attention  to  the  fact  that  some  arteries, 
although  not  necessarily  showing  any  sign  of  calcification  or  other 
degeneration,  feel  like  whip-cord  and  are  plainly  thickened,  though 
they  are  not  atheromatous.  I  regret  that  I  cannot  show  any  satis- 
factory microscopical  specimens  illustrating  this  fibroid  change. 
When  we  remember  that  the  thickness  of  an  artery  in  microscopical 
sections  of  the  tissues  from  fresh  bodies  depends  on  many  condi- 
tions, it  will  be  manifest  that  in  mummified  bodies  comparison  and 
inferences  are  practically  impossible.  Moreover,  at  present  1  can- 
not always  distinguish,  with  certainty,  fibrous  from  unstriated 
muscular  tissues  in  mummies.  I  repeat,  however,  that  to  the  naked 
eye  and  to  the  touch  some  arteries  are  distinctly  thickened  and 
fibrous. 

DISCUSSION   OF   RESULTS 

Nature  of  the  lesions. — There  can  be  no  doubt  respecting  the 
calcification  of  arteries,  and  that  it  is  of  exactly  the  same  nature  as 
we  see  at  the  present  day,  namely,  calcification  following  on 
atheroma. 

The  small  patches  seen  in  the  arteries  are  atheromatous,  and 
though  the  vessels  have  without  doubt  been  altered  by  the  three 
thousand  years  or  so  which  have  elapsed  since  death,  nevertheless 
the  lesions  are  still  recognisable  by  their  position  and  microscopical 
structure. 

The  earliest  signs  of  the  disease  are  always  seen  in  or  close  below 
the  fenestrated  membrane — that  is,  just  in  the  position  where  early 
lesions  are  seen  at  the  present  time.  The  disease  is  characterised 
by  a  marked  degeneration  of  the  muscular  coat  and  of  the  endothe- 
lium.    These  diseased  patches,  discrete  at  first,  fuse  together  later, 


ARTERIAL  LESIONS  IN  EGYPTIAN  MUMMIES  29 

and  finally  form  comparatively  large  areas  of  degenerated  tissue, 
which  may  reach  the  surface  and  open  out  into  the  lumen  of  the 
tube.  I  need  not  point  out  how  completely  this  description  agrees 
with  that  of  the  same  disease  as  seen  at  the  present  time. 

I  have  already  mentioned  the  absence  of  leucocytes  and  cellular 
infiltration,  and  need  not  therefore  return  to  it  here. 

In  my  opinion,  therefore,  the  old  Egyptians  suffered  as  much  as 
we  do  from  arterial  lesions  identical  with  those  found  in  the  present 
time.  Moreover,  when  we  consider  that  few  of  the  arteries  exam- 
ined were  quite  healthy,  it  would  appear  that  such  lesions  were  as 
frequent  three  thousand  years  ago  as  they  are  to-day. 


The  etiology  of  this  disease  three  thousand  years  ago  is  as  obscure 
as  it  is  in  modern  people.  One  cause  which  is  supposed  to  play  a 
part  in  modern  times,  namely  tobacco,  can  certainly  be  eliminated, 
as  this  drug  was  not  used  in  ancient  Egypt. 

Syphilis  also  can  be  eliminated  with  considerable  certainty,  as 
no  pathological  specimens  of  this  disease  in  ancient  Egyptians  have 
as  yet  been  discovered. 

Alcohol  played  a  part  in  Egyptian  social  life,  in  so  far  that  on 
festive  occasions  some  of  the  old  Egyptians  certainly  got  drunk,  as 
is  shown  by  pictures  found  in  Egyptian  tombs.  Beer  was  a  common 
beverage,  and  wine  was  not  only  made  in  the  country  but  also 
imported. 

It  is  clear,  however,  that  the  Egyptians  as  a  race  are  not  and 
never  have  been  habitual  drunkards. 

If  I  may  be  allowed  a  short  digression,  I  would  remark  in  this 
connection  that  my  personal  experience  has  led  me  to  call  in  ques- 
tion the  importance  of  alcohol  as  a  cause  of  arterial  disease.  During 
the  Mussulman  pilgrimage,  I  have  made  over  eight  hundred  post- 
mortem examinations  of  people  who  had  certainly  never  touched 
alcohol  in  their  lives,  and  I  have  found  that  disease  of  the  arteries 
is  certainly  as  common  and  occurs  as  early  in  total  abstainers  as  in 
people  who  take  alcohol  regularly. 

Another  favourite  cause  invoked  for  the  production  of  arterial 
disease  is  the  supposed  increased  wear  and  tear  of  modern  life. 


30  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

This  has  always  appeared  to  me  an  extraordinary  theory,  consider- 
ing that  people,  even  as  late  as  the  beginning  of  last  century,  worked 
far  harder  and  had  much  greater  difficulty  in  getting  their  living 
than  in  the  present  day.  In  my  opinion,  the  theory  that  the  wear 
and  tear  of  human  life  has  increased  is  a  myth,  the  fact  being  that 
our  life  is  easier  and  that  we  work  less  than  did  our  ancestors. 

There  is  no  evidence  that  old  Egyptians  worked  hard  either 
mentally  or  physically.  Indeed,  the  time-tables  of  workmen  which 
have  been  discovered  show  that  the  Egyptian  navvies  of  ancient 
times  toiled  practically  the  same  hours  as  the  Egyptians  do  now. 
They  enjoyed  a  holiday  every  seven  days,  as  do  many  nations  at 
the  present  time. 

I  do  not  think  we  can  accuse  a  very  heavy  meat  diet.  Meat  is 
and  always  has  been  something  of  a  luxury  in  Egypt,  and  although 
on  the  tables  of  offerings  of  old  Egyptians  haunches  of  beef,  geese, 
and  ducks  are  prominent,  the  vegetable  offerings  are  always  present 
in  greater  number.  The  diet  then  as  now  was  mostly  a  vegetable 
one,  and  often  very  coarse,  as  is  shown  by  the  worn  appearance  of 
the  crown  of  the  teeth. 

Nevertheless,  I  cannot  exclude  a  high  meat  diet  as  a  cause  with 
certainty,  as  the  mummies  examined  were  mostly  those  of  priests 
and  priestesses  of  Deir  el-Bahri,  who,  owing  to  their  high  position, 
undoubtedly  lived  well.  I  must  add,  however,  that  I  have  seen 
advanced  arterial  disease  in  young  modern  Egyptians  who  ate  meat 
very  occasionally.  In  fact,  my  experience  in  Egypt  and  in  the  East 
has  not  strengthened  the  theory  that  meat-eating  is  a  cause  of 
arterial  disease. 

Finally,  strenuous  muscular  exercise  can  also  be  excluded  as  a 
cause,  as  there  is  no  evidence  that  ancient  Egyptians  were  greatly 
addicted  to  athletic  sport,  although  we  know  that  they  liked  watch- 
ing professional  acrobats  and  dancers.  In  the  case  of  the  priests 
of  Deir  el-Bahri,  it  is  very  improbable,  indeed,  that  they  were  in 
the  habit  of  doing  very  hard  manual  work  or  of  taking  much 
muscular  exercise. 

I  cannot  therefore  at  present  give  any  reason  why  arterial  disease 
should  have  been  so  prevalent  in  ancient  Egypt.  I  think,  however, 
that  it  is  interesting  to  find  that  it  was  common,  and  that  three 


PLATE  III 


J 


■  : 


Fig.  4 


* 


PLATE  IV 


Fig.  9 


r^ 


h 


PLATE  V 


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Fig.  13 


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ARTERIAL  LESIONS  IN  EGYPTIAN  MUMMIES  31 

thousand  years  ago  it  represented  the  same  anatomical  characters 
as  it  does  now. 

DESCRIPTION  OF  PLATES  III-V 

(For  particulars  see  text) 

PLATE  III 

Fig.  1. — Pelvic  and  arteries  of  thigh  completely  calcified  (XVIII th-XXth 
Dynasties). 

Fig.  2. — Completely  calcined  profunda  artery  after  soaking  in  glycerine 
(XXIst  Dynasty). 

Fig.  3. — Partly  calcified  aorta  (XXVIIth  Dynasty). 

Fig.  4. — Calcified  patches  in  aorta  (XXVIIth  Dynasty). 

Fig.  5. — Calcified  atheromatous  ulcer  of  subclavian  artery  (XVIIIth- 
XXth  Dynasties). 

Fig.  6. — Patch  of  atheroma  in  anterior  tibial  artery  (glycerine).  The 
centre  of  the  patch  is  calcified  (XXIst  Dynasty) . 

Fig.  7. — Atheroma  of  brachial  artery  (glycerine)  (XXIst  Dynasty). 

Fig.  8. — Unopened  ulnar  artery,  atheromatous  patch  shining  through 
(glycerine)  (XXIst  Dynasty). 

PLATE    IV 

Fig.  9. — Section  through  almost  completely  calcified  posterior  peroneal 
artery  (low  power).  Van  Gieson  staining,  a,  ai,  0,2,  remnants  of  endothelium 
and  fenestrated  membrane ;   b,  calcified  patches.     Many  more  are  seen. 

Fig.  10. — Section  through  calcified  patch  of  ulnar  artery.  Same  stain. 
(Leitz,  Oc.  1,  XtV.)  a,  d,  calcified  patches;  b,  partially  calcified  muscular 
coat;  c,  annular  muscular  fibre. 

plate  v 

Fig.  11. — Section  through  atheromatous  patch  of  anterior  tibial  artery. 
Same  stain.  (Leitz,  Oc.  1,  X  iV)  a,  remains  of  endothelium;  b,  fenestrated 
membrane;  c,  muscular  coat;  d,  f,  membrane  coat  undergoing  degeneration; 
e,  completely  degenerated  remnants  of  muscular  coat. 

Fig.  12. — Section  through  atheromatous  patch  of  ulnar  artery.  Same 
stain.     (Leitz,  Oc.  1,  Xn-)     (Reference  letters  the  same  as  in  Fig.  n.) 

Fig.  13. — Section  at  edge  of  atheromatous  patch.  Haematoxylin  stain. 
(Leitz,  Oc.  1,  XAO  a,  leucocytes  (?).  The  atheromatous  part  on  the  left 
stains  intensely  dark  with  haematoxylin. 


AN   ERUPTION   RESEMBLING   THAT   OF   VARIOLA    IN 

THE  SKIN  OF  A  MUMMY  OF  THE  TWENTIETH 

DYNASTY  (1200-1100  B.C.)1 

{Journal  of  Pathology  and  Bacteriology,  Vol.  XV  [191 1]) 

The  body  from  which  the  skin  was  taken  was  that  of  a  tall  man 
of  middle  age.  It  was  brought  to  the  attention  of  one  of  us  by 
Professor  G.  Elliot  Smith  during  his  investigations  into  the  process 
of  mummification  as  illustrated  in  the  royal  mummies  in  the  Cairo 
Museum  of  Antiquities.  The  body  was  the  seat  of  a  peculiar  vesicu- 
lar or  bulbous  eruption  which  in  form  and  general  distribution  bore 
a  striking  resemblance  to  that  of  small-pox.  The  portion  of  skin 
we  were  permitted  to  remove,  and  which  forms  the  subject  of  the 
present  note,  was  taken  from  the  adductor  surface  of  the  right  thigh. 
The  eruption  on  the  inner  surface  of  the  thigh  was,  as  the  drawing 
shows  (see  Plate  VI,  Fig.  1),  a  closely  set  vesicular  one,  and  it  was  in 
this  situation  that  the  general  resemblance  to  small-pox  was  most 
noticeable. 

Small  portions  of  skin  were  treated  by  the  following  method:2 
(1)  The  tissue  was  softened  in  a  solution  of  sodium  carbonate  mixed 
with  alcohol  (alcohol,  100  parts;  water,  15  parts;  5  per  cent  solu- 
tion of  sodium  carbonate,  60  parts) ;  (2)  this  solution  was  replaced 
by  30  per  cent  alcohol,  and  the  tissue  gradually  brought  thereafter 
into  absolute  alcohol,  and  embedded  in  paraffin. 

A  reference  to  Plate  VI,  Fig.  2  (a  low-power  drawing  of  a  micro- 
scopical section),  shows  that  the  superficial  epithelial  covering  is 
very  much  disintegrated,  all  traces  of  Malpighian  layer  and  its 
papillae  having  disappeared.  No  nuclear  staining  is  discernible  in 
any  of  the  sections,  a  considerable  number  of  which  were  stained 
and  examined.  The  skin  is  everywhere  broken  up  into  a  series  of 
deeply  staining  lamellae  or  blocks.  The  dermis  shows  a  more 
definite  structure,  and  its  wavy  fibrillae  and  bundles  are  easily  dis- 

1  This  paper  was  written  with  A.  R.  Ferguson  as  junior  author. 

2  Marc  Armand  Ruffer,  British  Medical  Journal,  I  (London,  1909),  1005. 


ERUPTION  RESEMBLING  VARIOLA  33 

cernible.  No  distinct  vessels,  however,  can  be  made  out.  On 
looking  at  the  skin  layer  with  a  planatic  magnifier,  the  presence  of 
the  dome-shaped  vesicles  is  clearly  demonstrated.  They  must  have 
originated  and  developed  in  the  middle  of  the  prickle  layer,  i.e.,  in 
the  situation  in  which  the  small-pox  eruption  is  first  seen. 

In  the  fully  matured  state  of  the  vesicles,  as  they  are  present  in 
the  skin  under  consideration,  their  bases  are  formed  by  the  deepest 
(Malpighian)  layer,  whilst  the  elevated  superficial  layers  of  the 
epidermis  form  their  roofs.  In  one  or  two  of  the  sections  examined 
there  are  traces  of  the  vertical  septa  and  curtains  which  subdivide 
the  developing  vesicle  in  small-pox. 

The  structure  of  the  dermis  has  been  much  less  interfered 
with,  and  wavy  or  curling  hyaline  fibrillae  of  the  fibro-areolar 
tissue  are  as  distinct  as  in  many  similar  sections  from  freshly 
fixed  tissues.  There  are  no  traces  of  cellular  infiltration  beneath 
the  vesicles. 

Sections  stained  by  Gram's  method  reveal  very  large  numbers 
of  bacteria,  the  large  majority  of  which  are  strongly  Gram-positive. 
By  far  the  largest  proportion  of  these  occur  in  the  connective  tissue 
of  the  dermis,  where  they  are  met  with  either  in  dense  clusters  or 
diffusely  sprinkled  throughout  the  tissue,  following  the  lines  of 
separation  of  the  fibrillar  bundles.  Occasionally,  however,  they  are 
seen  to  follow  the  track  of  what  may  have  been  a  small  vessel,  the 
direction  of  which  is  more  or  less  oblique  to  the  surface  (see  Plate 
VI,  Fig.  3).  Owing  to  the  tenacity  with  which  the  epithelial  layer 
retains  the  Gram's  stain,  the  presence  of  bacteria  amongst  the 
epithelial  remains  is  impossible  to  establish.  Careful  search,  how- 
ever, in  sections  stained  with  methylene-blue,  leaves  no  doubt  as  to 
their  presence  here  also.  They  appear  to  be  more  numerous  in  the 
neighbourhood  of  the  vesicles  than  elsewhere.  The  organisms 
present  in  the  largest  numbers  are  short,  plump  bacilli,  often  swollen 
at  one  end,  so  as  in  many  instances  to  resemble  one  of  the  drum-stick 
bacilli.  Others  are  distinctly  beaded  in  form  or  have  a  torpedo 
shape.  A  cluster  of  bacilli  with  such  characters  bears  a  superficial 
resemblance  to  a  group  of  diphtheria-like  organisms.  A  few  micro- 
cocci also  occur;  these  are  more  apparent  in  sections  stained  with 
methylene-blue  (see  Plate  VI,  Fig.  4). 


34  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

It  is  certainly  unusual  to  find  the  sub-epithelial  tissue  so  invaded 
by  bacteria  in  small-pox  as  in  the  skin  under  consideration.  Nor  do 
we  wish  to  maintain  that  these  organisms  played  any  part  during 
the  progress  of  the  malady  (supposing  it  to  have  been  small-pox) ; 
but,  after  careful  examination  of  a  large  number  of  sections,  we  are 
of  opinion  that  these  bacteria  were  present  in  the  body  at  the  time 
of  death,  although  they  have  probably  multiplied  enormously  after 
death.  It  may  be  firmly  surmised  that  bacteria  already  present  in 
the  tissues  might  in  some  cases  greatly  multiply  locally  between  the 
time  of  death  and  the  mummification  proper. 

The  specimen  which  we  have  described  thus  provides  several 
points  of  quite  exceptional  interest,  among  which  may  be  mentioned : 

i.  The  probable  existence  of  small-pox  as  evidenced  by  as 
characteristic  an  eruption  as  the  conditions  of  preservation  of  such 
ancient  material  permits. 

2.  The  conservation  of  the  form  of  minute  organisms  such  as 
bacteria  after  such  a  phenomenal  period. 

3.  The  demonstrability  of  bacteria  in  mummified  tissues  by 
modern  staining  methods. 

DESCRIPTION  OF  PLATE  VI 

Fig.  1. — Naked-eye  view  of  skin. 

Fig.  2. — Microscopic  section  of  skin  under  low  power. 

Fig.  3. — Section  through  dermis;  Gram  and  eosin;  Zeiss,  DD,  Compens. 
Oc.  6. 

Fig  4. — Section  through  dermis;  methylene-blue ;  Zeiss,  DD,  Compens. 
Oc.  6. 


PLATE  VI 


F.oJ 


'   '  \*   Re3 


AKP. 


-  .   . 


*      -  - 


■ 


- 


i 


P.O.  2. 


ON   DWARFS    AND    OTHER   DEFORMED    PERSONS    IN 
ANCIENT  EGYPT 

(Bulletin  de  la  Societe  Archeologique  d'Alexandrie,  No.  13) 

It  is  not  a  little  strange  that  certain  deformed  individuals  should 
have  had,  from  time  immemorial,  and  should  even  now  have  a 
peculiar  fascination  for  some  men  and  women.  Of  these  misshapen 
human  creatures,  perhaps  the  most  popular  have  been  dwarfs  and 
hunchbacks.  Even  at  the  present  time,  dwarfs  are  kept  in  the 
household  of  several  Eastern  potentates,  and  some  have  a  distinct 
influence  at  court. 

It  is  altogether  outside  the  scope  of  this  paper  to  try  and  explain 
this  strange  taste,  the  reasons  for  which  are  very  complicated. 
There  is  a  superstition  for  instance,  not  only  in  the  Levant  but  also 
in  some  parts  of  Europe,  that  to  touch  a  hunchback's  hump  brings 
good  fortune.  ^Mythology  and  folklore  have  endowed  dwarfs  or 
gnomes  with  supernatural  powers.)  Hunchbacks  also  enjoy  an 
unmerited  reputation  as  merry  grigs;  witness  the  French  expression 
s'amuser  comme  un  bossu. 

Dwarfs  were  kept  as  pets  in  the  palaces  of  kings,  princes,  and 
nobles  during  the  Renaissance  and  Middle  Ages.  I  would  suggest, 
though  without  being  able  to  adduce  any  proof,  that  this  fashion 
was  introduced  in  Europe  by  the  Crusaders  returned  from  the  East. 
Painters  such  as  Raphael,  Titian,  Mantegna,  Veronese,  Carpaccio, 
and  others  introduced  dwarfs  into  their  pictures,  nor  did  they 
disdain  to  paint  their  portraits.  An  excellent  account  of  this  branch 
of  art  has  been  written  by  Richer.1 

Among  the  Romans,  nani  were  kept  in  rich  houses  for  the  amuse- 
ment of  inmates  and  guests.2  The  fashion  may  have  come  from 
Syria,  but  not  from  Greece,  as  dwarfs  do  not  seem  to  have  been  a 
feature  in  households  of  Greece  proper  before  the  Roman  conquest. 
In  Lucian's  banquet,  the  host  introduces  a  dwarf  to  amuse  his 

1  (Jr.  J'aul  Richer,  L'Arl  el  la  Mtdecine. 
'  See  Smith's  Dictionary  of  Archeology. 


36  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

guests,  and  he  falling  foul  of  the  pompous  philosopher  present,  a 
fierce  fight  ensues  between  the  two  ill-matched  adversaries,  the 
philosopher  getting  much  the  worst  of  it.  At  Rome,  great  ladies 
especially  delighted  in  dwarfs,  as  Livia  and  Seneca's  wife;  and  the 
prevalence  of  the  fashion  at  Rome  is  marked  by  Suetonius,  when  he 
mentions  particularly  that  Augustus  did  not  care  for  them. 

There  is  no  clear  distinction  between  nanus  or  pumilio  or 
pumilus,  the  dwarf,  and  morio,  the  jester,  since  the  jesters  seem  to 
have  been  selected  for  their  absurd  appearance  as  well  as  for  that 
power,  often  found  in  the  malformed,  of  making  comical  remarks 
for  which  mediaeval  jesters  were  in  demand.  There  seem  to  have 
been  several  kinds  of  dwarfs.  One  of  them1  is  described  as  "acuto 
capite  et  auribus  longis"  and  in  another  place2  it  is  said  "si  solum 
spectas  hominis  caput,  Hectora  credas,  si  stantem  videas  Astyan- 
acta  putas, "  which  indeed  exactly  describes  the  deformity  due  to 
the  comparatively  big  head  and  short  limbs  of  an  achondroplastic 
dwarf.  Some  dwarfs  were  possibly  cretins  or  myxoedematous 
dwarfs.3  Misshapen  limbs  as  well  as  small  stature  added  to  their 
price,  and  the  most  revolting  part  of  the  fashion  was  that  the 
deformity  was  sometimes  caused  by  artificial  means,  the  children 
being  kept  in  a  case  or  frame  which  would  stunt  or  distort  their 
growth.4    The  Romans  kept  female  as  well  as  male  dwarfs. 

Amongst  the  extreme  cases  recorded  on  ancient  authority  one 
may  notice  Philetus,  a  contemporary  of  Hippocrates,  who  was  so 
small  that  he  "had  to  ballast  himself  to  avoid  being  carried  away 
by  the  wind";  the  Egyptian  dwarf  mentioned  by  Nicephorus 
Callistus,  who  "at  the  age  of  25  years  did  not  exceed  a  partridge  in 
size, "  and  lastly  the  poet  Arisastus,  of  whom  Athenaeus  records  that 
he  was  so  small  that  "no  one  could  see  him. "  I  leave  the  reader 
to  make  whatever  allowance  he  thinks  fit  for  exaggeration. 

Little  is  known  about  dwarfs  among  the  Jews,  except  that  they 
are  mentioned  among  those  who  were  forbidden  access  to  the 
temple. 

1  Mart.  vi.  39.  2  Mart.  xiv.  212. 

3  Mart.  viii.  12. 

*  I  confess  to  much  scepticism  with  regard  to  the  possibility  of  making  dwarfs 
artificially. 


ON  DWARFS  37 

In  Egypt,  dwarfs  were  common,  and  indeed,  the  pictures, 
statuettes,  etc.,  found  in  this  country  copied  nature  with  such 
fidelity  that  in  many  cases  it  is  possible  to  recognise  to  what  disease 
the  deformity  was  due. 

Nevertheless,  many  Egyptologists,  instead  of  regarding  dwarfs 
as  pathological  specimens,  look  upon  them  as  having  been  pygmies 
brought  into  Egypt  from  Central  Africa.  In  order  to  illustrate  this 
view  I  can  do  no  better  than  quote  the  most  modern,  excellent,  and 
learned  work,  namely  the  History  of  Egypt  by  Breasted. 

Breasted  relates  that: 

in  the  young  king's  [Pepi  II,  about  2400  B.C.]  second  year,  Harkhuf,  one  of  the 
king's  best  officers,  was  for  the  fourth  time  despatched  to  Yam,1  whence  he 
returned  bringing  a  rich  pack  train  and  a  dwarf  (Figs.  41,  75)  from  one  of  the 
pygmy  tribes  of  Central  Africa. 

Breasted  adds: 

These  uncouth,  bandylegged  figures  were  highly  prized  by  the  noble  class 
of  Egypt;  they  were  not  unlike  the  merry  genius  Bes  in  appearance,  and  they 
executed  dances  in  which  the  Egyptians  took  the  greatest  delight.  The  land 
from  which  they  came  was  connected  by  the  Nile  dwellers  with  the  mysterious 
regions  of  the  West,  the  sojourn  of  the  dead,  which  they  called  "the  land  of 
the  spirits"  and  the  dwarfs  from  this  sacred  land  were  especially  desired  for 
the  dances  with  which  the  king's  leisure  hours  were  diverted. 

I  have  copied  Fig.  41  (Plate  VIII,  Fig.  1),  and  Fig.  75  of 
Breasted's  book  is  represented  here  by  the  excellent  photograph  of 
the  dwarf  Chnoum-hotep,  given  me  by  my  friend  His  Excellency 
E.  Brugsch  Pasha  (Plate  VII).  A  glance  at  these  figures  shows 
that  they  do  not  represent  pygmies,  but  typical  achondroplastic 
dwarfs. 

Granted  that  Egyptians  brought  pygmies  back  from  Central 
Africa,  it  does  not  follow  that  all  or  even  the  majority  of  dwarfs  in 
Ancient  Egypt  were  pygmies.  I  have  examined  carefully  hundreds 
of  illustrations  of  people  depicted  in  ancient  Egyptian  monuments, 
without  finding  a  true  pygmy  among  them. 

On  the  contrary,  the  dwarfs  figured  in  tombs  are  always  typi- 
cally pathological  specimens.     Indeed,  Edward  Tyson  in  1699  had 

'  A  country  in  the  South,  probably  Central  Africa. 


38  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

already  pointed  out  the  mistake  into  which  some  authors  had  fallen 
by  grouping  together  pygmies  and  dwarfs.     He  wrote : 

Now  by  Men  Pygmies  we  are  by  no  means  to  understand  Dwarfs.  In  all 
Countries,  and  in  all  Ages,  there  have  been  now  and  then  observed  such 
bvMiniature  of  Mankind,  or  under-sized  Men.  Cardan  (de  subtilitate  lib.  II, 
p.  458)  tells  us  that  he  saw  one  carried  in  a  Parrot's  cage,  that  was  but  a  Cubit 
high.  Nicephorus  tells  us  (Nicephor.  Histor.  Ecclesiast.  lib.  12.  cap.  37)  that 
in  Theodosious  the  Emperour's  time,  there  was  one  in  Aegypt  that  was  no 
bigger  than  a  Partridge;  yet  what  was  to  be  admired,  he  was  very  Prudent, 
had  a  sweet  clear  Voice,  and  a  generous  Mind;  and  lived  Twenty  Years.  So 
likewise  a  King  of  Portugal  sent  to  a  Duke  of  Savoy,  when  he  married  his 
daughter  to  him,  an  Aethiopian  Dwarf  but  three  Palms  high  (Happelius  in 
Relat.  Curiosis.  No.  85,  p.  677).  And  Thevenot  (Voyage  de  Levant  lib.  2. 
c.  68.)  tells  us  that  the  Present  made  by  the  King  of  the  Abyssins,  to  the 
Grand  Signor,  of  several  little  black  Slaves  out  of  Nubia,  and  the  countries 
near  Aethiopia,  which  being  made  Eunuchs,  were  to  guard  the  Ladies  of  the 
Seraglio.  And  a  great  many  such  like  Relations  there  are.  But  these  being 
only  Dwarfs,  they  must  not  be  esteemed  the  Pygmies  we  are  enquiring  about, 
which  are  represented  as  a  Nation,  and  the  whole  Race  of  them  to  be  of  the 
like  stature.1 

I 

I  will  begin  by  the  description  of  a  dwarf  who  has  already  figured 
as  an  achondroplastic  dwarf  in  Dr.  P.  Richer's  book. 

The  name  of  this  person  was  Chnoum-hotep  (Plate  VII),  and 
his  limestone  statuette,  now  in  the  Cairo  Museum,  was  found  at 
Saqqarah.  He  lived  in  the  Vth  Dynasty  (about  2700  B.C.),  that 
is,  about  4,500  years  ago. 

Le  nain  a  la  t£te  grosse,  barrelee,  cantonnee  de  deux  vastes  oreilles.  La 
figure  est  niaise.  [I  do  not  agree  with  Sir  Gaston  here,  as  the  face  to  me 
appears  rather  cunning  than  otherwise.]  L'ceil,  ouvert  etroitement,  est 
retrousse  vers  les  tempes,  la  bouche  mal  fendue.  La  poitrine  est  robuste  et 
bien  developpee,  mais  le  torse  n'est  pas  en  proportion  avec  le  reste  du  corps ; 
l'artiste  a  eu  beau  s'ingenier  a.  en  voiler  la  partie  inferieure  sous  une  ample 
jupe  blanche,  on  sent  qu'il  est  trop  long  pour  les  bras  et  pour  les  jambes.  Le 
ventre  se  projette  en  pointe  et  les  hanches  se  retirent  pour  faire  contrepoids 
au  ventre.  Les  cuisses  n'existent  guere  qu'a  l'etat  rudimentaire,  et  l'individu 
entier,  campe  qu'il  est  sur  des  petits  pieds  contrefaits,  semble  etre  hors  d'aplomb 
et  pret  a  tomber  face  contre  terre. 

The  description  is  from  every  point  of  view  perfectly  correct. 
It  is  obvious  that  the  large  head  and  bust  are  out  of  all  proportion 

1  A  Pathological  Essay  Concerning  the  Pygmies  of  the  Ancients,  by  Edward  Tyson, 
a.d.  1699,  now  edited,  with  an  introduction  treating  of  pygmy  races  and  fairy  tales,  by 
Bertram  C.  A.  Windle. 


ON  DWARFS  39 

to  the  diminutive  lower  limbs.  The  knot  in  the  girdle  is  well  above 
the  symphysis  pubis,  which,  judging  from  the  position  of  the 
umbilicus,  I  take  to  be  level  with  or  just  a  little  below  the  tips 
of  the  fingers.  The  femur  is  very  short,  and  there  is  same  diminu- 
tion in  length  of  the  bones  of  the  legs.  The  feet  are  squat  and  flat. 
The  bones  of  the  upper  limbs,  as  compared  to  the  length  of  the 
trunk,  are  much  shorter  than  they  should  be,  as  the  tips  of  the 
fingers  only  reach  the  top  of  the  thigh. 

The  arms  do  not  hang  down  straight,  but  away  from  the  sides, 
and  the  palms  of  the  hands  are  turned  forwards.  There  is  probably 
some  deformity  of  the  legs  also,  but  this  is  hidden  by  the  skirt. 
The  hands  are  squat.  A  certain  amount  of  lordosis1  is  present  also. 
Otherwise  the  little  man  is  strongly  built,  and  the  muscular  develop- 
ment of  the  arms  specially  well  marked. 

In  fact,  this  statuette  shows  the  chief  characteristics  of  an  achon- 
droplastic  dwarf,  namely  disproportion  between  the  size  of  the 
trunk  and  limbs,  the  latter  being  much  too  short  for  the  former,  a 
head  too  large  in  proportion  to  the  size  of  the  body,  and  good 
muscular  development.  The  description  of  achondroplasia  in  any 
modern  textbook  of  medicine  exactly  applies  to  this  dwarf. 

The  only  other  possible  diagnosis,  namely  that  of  myxoedema, 
is  negatived  by  the  fact  that  this  person  held  a  high  position  at 
court.  His  tomb  was  one  of  the  finest  and  richest  at  Saqqarah,  and 
according  to  Maspero  he  was  "Chief  of  the  Perfumes"  or  "Head  of 
the  Wardrobe."  No  myxoedematous  dwarf,  whose  mental  faculties 
are  generally  impaired,  could  have  held  court  functions,  which, 
among  the  intrigues  of  the  East,  must  have  required  no  little  tact 
and  cleverness. 

Achondroplastic  dwarfs  are  not  stupid  as  a  rule,  and  are  often 
distinctly  cunning.  Some  have  occupied  important  functions  at 
court  as  jesters.  Muscularly  they  are  well  developed  and  not 
unfrequently  at  the  present  time  earn  their  living  as  dancers  and 
acrobats.2  As  will  be  seen  presently,  they  had  definite  duties 
assigned  them  in  Egyptian  households. 

'  I.'-.,  forward  curvature  of  the  lumbar  spine. 

'  lioth  in  Pari-  and  London  a<  hondroplastic  dwarfs  are  appearing  on  the  music- 

at  I  be  pre  ent  time. 


40  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  other  illustration,  which  Breasted  gives  as  representing 
pygmies,  comes  from  a  tomb  of  the  Old  Empire  and  represents  four 
dwarfs  working  at  jewelry.  The  copy  which  is  shown  here  (Plate 
VIII,  Fig.  i)  demonstrates  that  these  persons  were  not  pygmies, 
but  achondroplastic  dwarfs  of  the  same  class  as  Chnoum-hotep. 
Though  the  body  is  well  developed,  the  arms  and  especially  the 
lower  limbs  are  stunted.  The  picture  shows  incidentally  how  care- 
fully Egyptian  artists  followed  nature  sometimes,  as  in  the  extreme 
left  of  the  picture  a  fat  man  has  been  introduced  whose  obesity  is 
in  sharp  contrast  with  the  spare  bodies  of  this  fellow  workman. 

Several  other  achondroplastic  dwarfs  have  been  copied  by 
archaeologists  on  monuments  of  ancient  Egypt.  Perhaps  the  oldest 
is  the  "dwarf  of  Zer"  (Plate  VIII,  Fig.  2)  discovered  by  Flinders 
Petrie  at  Abydos,  and  dating  from  about  4715-4658  B.C. 

The  drawing,  a  mere  outline  on  a  bowl  of  metamorphic  rock, 
is  wonderfully  spirited,  as  Petrie  has  remarked.  Some  of  the 
characteristics  of  an  achondroplastic  dwarf  are  obvious,  as  for  in- 
stance the  great  length  and  breadth  of  the  trunk  as  compared  with 
the  lower  limbs.  The  shortness  of  the  thighs  and  the  great  muscu- 
lar development  are  noticeable,  but  the  right  lower  limb  is  so 
foreshortened  that  it  is  practically  impossible  to  say  where  the  thigh 
ends  and  the  leg  begins.  The  arms  are  short  also.  The  head,  how- 
ever, is  not  characteristic,  being  small  and  the  features  sharp  and 
intelligent.  Nevertheless,  the  other  characteristics  justify  the 
diagnosis  of  achondroplasia.  It  is  only  right  to  add  that  Petrie 
had  recognised  the  dwarfish  nature  of  this  person. 

Many  similar  dwarfs  are  depicted  on  Egyptian  monuments,  and 
a  few  more  instances  may  be  given. 

Plate  VIII,  Fig.  3,  shows  two  dwarfs  from  the  tomb  of  Aba, 
about  2400  B.C.,1  at  work  in  the  manufacture  of  necklaces.  The 
contrast  between  the  size  of  the  trunk  and  the  lower  limbs  is  well 
marked,  though  other  details  are  obscured. 

In  the  same  work2  a  dwarf  (Plate  VIII,  Fig.  4),  perhaps  one  of 
the  four  just  mentioned,  is  seen  standing  under  his  master's  chair 
holding  a  mirror  in  his  hand.     The  dwarf  looks  exceedingly  small, 

1  N.  de  G.  Davies,  Deir  el  Gebrawi,  Plate  XIII. 

2  Plate  XVII. 


ON  DWARFS  41 

but  as  the  Egyptian  artist  always  drew  the  master  much  larger  in 
proportion  to  the  other  people  in  the  picture,  no  opinion  can  be 
formed  regarding  the  real  size  of  the  little  man. 

Two  more  achondroplastic  dwarfs  (Plate  VIII,  Fig.  5)  are  repre- 
sented on  the  walls  of  a  tomb  at  Deshasheh,  dating  from  the  middle 
of  the  Vth  Dynasty  (about  2700  B.C.).1  The  one  on  the  left  of  the 
picture  holds  a  necklace  in  his  right  hand  and  carries  a  box  on  his 
head,  whereas  the  other  is  busy  at  the  work  table.  In  both  the 
characteristic  deformity  is  accurately  shown.    • 

In  the  same  tomb  a  dwarf  is  represented  (Plate  VIII,  Fig.  6) 
holding  a  sling  ( ?)  in  his  hand  and  standing  in  the  prow  of  a  boat. 
The  contrast  between  the  slim  oarsman  and  the  squat  dwarf  is  very 
noticeable. 

In  the  tombs  of  Sheikh  Said,  dating  from  the  Vth  Dynasty  prob- 
ably, a  dwarf  (Plate  VIII,  Fig.  7)  holding  a  monkey  in  leash  stands 
under  his  master's  chair,  and  another  (Plate  VIII,  Fig.  8)  leads  a 
greyhound.  Although  both  figures  are  in  a  bad  state  of  preserva- 
tion, yet  the  deformities  are  recognisable. 

The  female  dwarf  (Plate  IX,  Fig.  9)  discovered  at  Athribis2 
dates  from  the  IVth  Dynasty.  It  is  not  a  very  good  specimen, 
though  the  squat  figure  shows  off  the  slim,  naked  girl  walking  in 
front. 

Other  achondroplastic  dwarfs  might  doubtless  be  found  on 
Egyptian  monuments,  but  in  my  opinion  the  examples  copied  here 
are  sufficient  to  show  that  this  disease  has  been  in  existence  for  the 
last  five  thousand  years  at  least,  and  that  it  presented  then  the  same 
pathological  characteristics  as  it  does  now. 

The  occupations  of  these  little  people,  in  the  majority  of  cases, 
appear  to  have  been  of  two  kinds.  The  first  was  the  care  of  pet 
animals,  and  it  is  not  a  little  odd  that  in  comparatively  modern 
times  they  should  have  been  similarly  employed.  The  Egyptian 
dwarf  is  seen  leading  his  master's  greyhound  or  holding  a  monkey 
in  leash,  the  Italian  dwarf  is  caressing  a  greyhound  (see  Tiepolo's 
picture  in  the  Berlin  Museum),  and  Valesquez  has  painted  an 
English  dwarf  holding  a  greyhound  in  leash  (see  the  picture  of  Don 
Antonio,  the  Englishman,  by  Velasquez  in  the  Madrid  Museum). 

1  Petrie,  Desha  tfu  h.  '  Pel  rie,  Athribis,  Plate  I. 


42  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Another  occupation  was  the  care  and  making  of  jewelry.  An 
eminent  Egyptologist  has  suggested  to  me  that  valuables  were 
entrusted  to  dwarfs,  because  their  deformities  provided  an  easy 
means  of  identification  if  they  ran  away  with  their  master's  prop- 
erty.    This  view  appears  to  me  to  be  probably  correct. 

II 

I  may  now  pass  on  to  the  description  of  some  other  malformed 
persons  depicted  on  Egyptian  tombs.  The  first  that  I  would  draw 
attention  to  represents  two  young  people  copied  by  Mr.  Percy  New- 
berry, from  the  walls  of  tombs  at  Beni-Hassan,  dating  from  the  XI th 
and  Xllth  Dynasties  (about  2000  B.C.).  One  of  them  has  already 
been  figured  by  Richer  in  the  work  quoted  already  (Plate  IX,  Fig. 
1  ob  and  Fig.  n).  The  diagnosis  here  is  easy,  for  the  position  of 
the  feet  is  typical  of  talipes  equino-varus.1  Notice  the  contrast 
between  these  youths  and  the  achondroplastic  dwarfs  previously 
described,  for  in  the  case  of  the  club-footed  people,  the  proportion 
between  the  length  of  the  limbs  and  that  of  the  body  is  almost 
normal. 

The  female  dwarfs  (Plate  IX,  Fig.  13)  with  well-marked  talipes 
equino-varus  are  represented  on  the  walls  of  the  tomb  at  El  Amarna, 
dating  from  the  XVIIIth  Dynasty  (1375  B.C.).  Next  to  them  the 
artist  has  represented  one  of  the  king's  daughters,  and  the  contrast 
between  the  slim  child  and  the  deformed  little  figures  is  most 
striking. 

Ill 

Two  other  figures  show  the  typical  features  of  Pott's  disease. 
In  the  first  (Plate  IX,  Fig.  15)  discovered  in  the  tombs  of  Beni- 
Hassan  (Xlth-XIIth  Dynasties,  about  2000  B.C.)  the  characteristic 
deformity  occupies  the  upper  dorsal  and  lower  cervical  region.  In 
consequence,  the  head  is  protruded  slightly  forwards.  The  other 
(Plate  IX,  Fig.  14)  was  copied  from  a  tomb  at  El  Amarna  and  dates 
from  the  XVIIIth  Dynasty.  The  hump  in  this  case  occupies  the 
lower  dorsal  or  lumbar  region. 

These  are  the  only  two  examples  of  Pott's  disease  that  I  have 
found  so  far  on  old  Egyptian  monuments.     They  acquire  impor- 

'Anglice:  club-foot. 


ON  DWARFS  43 

tance  from  the  fact  that  they  date  from  nearly  two  thousand  years 
before  Christ. 

Mme  Constantine  Sinadino  of  Alexandria  owns  a  little,  marble 
statuette  dating  from  the  Greek  period,  which  shows  the  charac- 
teristic deformity  of  Pott's  disease  (Plate  X,  Fig.  2). 

Another  statuette  in  the  Alexandria  Museum  hollowed  in  the 
shape  of  a  pot,  and  dating  from  the  Graeco-Roman  period,  shows 
a  similar  deformity  (Plate  X,  Fig.  3). 

IV 

There  is  some  evidence  also  that  rickets  existed  in  Old  Egypt. 
The  man  outlined  in  Plate  IX,  Fig.  106,  shows  considerable  enlarge- 
ment of  the  cranium,  which  is  evident  on  comparing  his  head  with 
those  of  his  companions.  The  smallness  of  the  face  accentuates 
the  deformity.  The  squareness  of  the  trunk  suggests  an  adult  man, 
the  breadth  being  out  of  proportion  to  the  length  of  the  body. 
On  the  other  hand,  the  trunk  does  not  appear  to  be  much  too  long 
for  the  limbs. 

The  lower  limbs  are  greatly  deformed  and  the  bowed  legs  are 
typical  of  rickets.  The  foot  is  flat,  whereas  the  arch  of  the  foot  in 
people  from  the  same  period  is  high. 

In  my  opinion,  we  are  here  in  presence  of  a  case  of  rickets,  with 
evident  deformity  of  the  legs,  and  probably  some  amount  of  hydro- 
cephalus also.  Achondroplasia  and  myxoedema  are  plainly  out  of 
the  question. 

A  dwarf  (Plate  IX,  Fig.  12)  from  another  tomb  at  Beni-Hassan 
shows  deformities  similar  to  the  preceding  one.  The  head,  how- 
ever, does  not  appear  to  be  larger  than  usual.  The  little  person 
was  pot-bellied,  for  the  abdomen  is  prominent,  and  the  curve  of  the 
waist,  usually  emphasised  in  Egyptian  pictures,  is  absent  here. 
The  bowed  legs  are  characteristic  of  rickets.  The  arch  of  the  foot 
has  almost  disappeared. 

V 

I  now  proceed  to  describe  one  statuette  and  two  bas-reliefs  in 
which  the  etiology  of  the  deformities  is  not  quite  plain. 

The  first  (Plate  X,  Fig.  2)  is  a  small  statuette,  now  in  the 
Ashmolean  Museum  at  Oxford.     The  work  is  rough,  and  the  figure 


44  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

in  a  bad  state  of  preservation,  for  the  left  leg  is  broken.  It  is  inter- 
esting to  find  that  the  British  artist  who  repaired  it  was  obliged  to 
make  a  plaster  leg  bending  outwards  in  order  that  it  should  fit  the 
other  leg.  Although  the  lower  limbs  are  short  as  compared  to  the 
trunk,  yet  the  disproportion  is  not  marked  enough  to  warrant 
the  diagnosis  of  achondroplasia.  The  deformity  was  probably  due 
to  rickets.  The  statuette  dates  from  the  1st  Dynasty  and  is  at 
least  five  thousand  years  old. 

A  bas-relief  (Plate  IX,  Fig.  16)  of  the  1st  Dynasty  figured  by 
Flinders  Petrie  (Royal  Tombs,  II,  Plate  XXVIII,  the  tomb  of  Zer- 
Ta)  shows  another  interesting  dwarf.  The  work  is  primitive  and 
coarse,  though  the  figure  is  full  of  movement.  The  prominent 
pathological  features  are  the  bowed  legs,  the  stout  body,  and  the 
shortness  of  the  arms.  Owing  to  the  want  of  finish  in  the  carving, 
the  size  of  the  head  cannot  be  ascertained  with  accuracy,  though  it 
appears  somewhat  too  large  as  compared  with  the  body. 

An  exact  diagnosis  is  in  my  opinion  impossible.  Considering 
the  absence  of  any  marked  disproportion  between  the  size  of  the 
body  and  that  of  the  legs,  considering  also  the  well  marked  deform- 
ity of  the  legs,  I  conclude  that  the  disease  which  had  produced  these 
deformities  was  probably  rickets. 

Perhaps  the  most  striking  figure  which  has  been  assumed  to  be 
a  dwarf  (see  Richer,  loc.  cit.)  is  that  of  the  celebrated  "Queen  of 
Punt"  (see  Plate  XI)  which  was  carved  in  relief  on  the  walls  of  the 
Temple  of  Deir  el  Bahri  and  is  now  in  the  Cairo  Museum. 

The  authorities  of  the  Cairo  Museum  consider  this  person  to 
have  been  a  steatopygous  woman.  Richer,  on  the  other  hand, 
thinks  that  the  deformity  was  typical  of  achondroplasia.  He 
expresses  himself  as  follows : 

Derriere  lui,  le  roi  de  Poun  [Anglice:Punt],  se  trouve  sa  femme.  Celle-ci 
a  sa  chevelure  soigneusement  peignee  et   ramassee  en  queue  epaisse  par 

derriere, Quant  a  ses  traits,  ils  sont  assez  reguliers,  quoiqu'un  peu  virils, 

mais  tout  le  reste  de  sa  personne  est  repoussant.  Ses  bras,  sa  poitrine,  ses 
jambes,  sont  comme  charges  de  chairs  ramollies;  le  bassin  se  projette  en  arriere, 
et  accuse  ure  deformite  que  l'artiste  egyptien  a  rendue  avec  une  naivete 
surprenante. 

Faut-il  voir  la  l'ensellure  et  la  preeminence  des  fesses  signalees  par  Parrot, 
chez  certains  nains,  ou  bien,  comme  le  pense  M.  Bordier,  ne  s'agirait-il  pas  de 


ON  DWARFS  45 

la  representation  du  type  des  Boschemans,  avec  Pensellure  et  la  steatopygie 
characteristiques  ?  Broca  fait  une  remarque  qui  ruine  cette  derniere  hypothese. 
II  fait  remarquer  que  l'humerus  parait  plus  court  que  le  radius.  Or,  ce  fait 
ne  se  rencontre  dans  aucune  race,  moins  chez  les  Boschemans  que  chez  aucune 
autre.  Nous  ajouterons  que  la  disproportion  des  membres  tres  courts  avec 
le  torse  trop  long,  leur  surcharge  graisseuse,  s'ajoutent  aux  signes  ci-dessus 
releves,  pour  faire  de  cette  figure  une  veritable  naine  se  rattachant  a  la  categorie 
des  achondroplasiques. 

The  problem  is  rendered  more  difficult  by  the  fact  that  the  legs, 
abdomen,  and  head  are  drawn  in  profile  and  the  chest  almost  full  face. 

My  opinion  agrees  with  Richer 's  in  so  far  that  I  do  not  think 
that  the  Queen  of  Punt  was  either  a  steatopygous  woman  nor  a 
Bushwoman.  The  first  hypothesis  is  disproved  by  her  face,  which 
is  certainly  not  that  of  a  Bushwoman  but  is  rather  of  a  Semitic  type. 

The  diagnosis  of  steatopygia  can  also  be  shown  to  be  incorrect. 

The  chief  characteristic  of  a  steatopygous  woman  is  the  dis- 
proportion between  the  size  of  the  buttocks  and  thighs.  If,  in  the 
case  of  the  Queen  of  Punt,  a  horizontal  line  be  drawn  just  below 
the  top  of  the  thigh,  it  will  be  noticed  that,  as  a  matter  of  fact,  the 
buttocks  do  not  stand  out  at  all  prominently  above  that  line; 
whereas  in  a  steatopygous  woman,  a  Hottentot,  for  instance,  the 
prominence  is  very  noticeable.  In  the  Queen  of  Punt,  the  most 
marked  characteristic  is  the  pronounced  lordosis.  The  lumbar 
spine  is  bent  forwards,  the  whole  abdomen  has  sunk,  and  the 
umbilicus  is  only  a  little  above  the  level  of  a  line  drawn  across  the 
lower  edge  of  the  gluteal  fold.  Very  remarkable  also  is  the  depres- 
sion of  the  symphysis  pubis.  In  any  case,  the  lordosis  alone  is 
sufficient  to  account  for  the  size  of  the  buttocks. 

It  is  true  that  steatopygous  women  look  as  if  they  had  lordosis, 
but  in  them,  if  the  deformity  exists  at  all,  it  is  very  slight  indeed. 

Although,  therefore,  I  consider  the  diagnosis  of  steatopygia  as 
not  proven,  yet  neither  do  I  consider  Her  Majesty  of  Punt  as  an 
achondroplastic  dwarf. 

In  the  first  place,  it  cannot  be  proven  that  the  Queen  was  smaller 
than  her  companions.  On  the  bas-relief  she  is  just  as  tall  as  the 
men  preceding  and  following  her.  The  point  is  perhaps  not  of 
great  importance,  as  it  may  be  argued  that  the  artist  drew  her  the 
same  size  as  her  companions  for  the  sake  of  symmetry.     Much 


46  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

more  important,  however,  is  the  fact  that  although  there  is  undoubt- 
edly some  disproportion  between  the  length  of  the  trunk  and  that 
of  the  lower  limbs,  yet  this  is  rendered  very  prominent  by  the 
depression  of  the  umbilicus.  Were  it  not  for  the  depression  of  the 
abdomen,  the  umbilicus  would  be  situated  about  one  and  a  half 
centimetres  higher  than  it  is  in  the  photograph,  which  would 
correspond  pretty  nearly  to  the  centre  of  the  figure. 

Another  important  fact  against  the  diagnosis  of  achondroplasia 
is  that  the  arms  are  by  no  means  short,  and  I  can  see  no  reason  for 
supposing,  as  Broca  did,  that  the  humerus  was  shorter  than  the 
radius.  The  hand  and  fingers  are  shapely  and  very  unlike  the  squat 
extremities  of  the  achondroplastic  dwarf. 

One  fact  must  not  be  forgotten,  which  appears  not  to  have  been 
noticed  by  all  those  who  have  examined  this  bas-relief,  namely  that 
the  Queen  of  the  Punt  had  a  daughter.  Part  of  the  bas-relief 
discovered  by  Mariette  has  unfortunately  been  lost  and  the  missing 
portion  showed  the  daughter  of  the  Queen.  The  fact  is  mentioned 
by  Naville  {The  Temple  of  Deir  el  Bahri),  and  Sir  Gaston  Maspero 
informs  me  that  the  daughter  showed  the  same  deformities  as  the 
mother,  though  to  a  slighter  degree.  Although  achondroplasia  has 
been  known  to  be  hereditary,  yet  it  appears  to  me  that  the  extreme 
lordosis  of  the  Queen  would  certainly  have  interfered  with  parturi- 
tion, and  that  it  is  very  probable  therefore  that  the  deformity  was 
an  acquired  one. 

I  confess  my  inability  to  propose  any  definite  diagnosis  for  the 
present.  The  lordosis  is  self-evident,  but  I  cannot  account  for  the 
redundant  flesh  on  the  limbs  and  trunk,  whereas  the  face,  hands, 
feet,  and  apparently  the  breasts  also,  have  remained  normal.  I  say 
flesh  and  not  fat  advisedly,  for  the  enlargement  of  the  thighs,  etc., 
resembles  far  more  the  jelly-like  tissues  of  certain  cases  of  elephan- 
tiasis than  adipose  tissue. 

The  deformity  is  not  due  to  filaria,  for  all  the  limbs  and  the  trunk 
are  enlarged.  I  have  seen  in  Egyptian  women  enlargement  of  one 
limb  exactly  corresponding  to  that  seen  in  the  Queen  of  Punt,  and 
neither  during  the  day  nor  at  night  did  I  find  parasites  in  their 
blood.  This  deformity  may  perhaps  occur  in  several  limbs? 
I  cannot  say. 


ON  DWARFS  47 

VI 

Among  the  dwarfs  of  Egypt,  the  gods  Bes  and  Phtah  have  also 
been  mentioned.  The  first  is  supposed  to  have  been  copied  from  a 
rickety  dwarf  and  the  other  from  an  achondroplastic  dwarf.  I 
have  examined  a  great  many  statuettes  of  the  latter  without 
arriving  at  any  definite  conclusion  for  the  present.  Some  statu- 
ettes, however,  show  a  distinct  swelling  in  the  region  of  the  navel, 
most  resembling  an  umbilical  hernia.  The  former,  in  my  opinion, 
is  not  a  dwarf  at  all.  As,  however,  the  discussion  of  this  ques- 
tion would  entail  entering  into  a  great  many  archaeological  prob- 
lems, I  must  leave  this  subject  until  another  occasion.  For  the 
same  reason,  it  would  also  be  inexpedient  to  describe  the  many 
dwarfish  figures  found  in  Egypt  which  date  from  the  Greek  and 
Roman  times. 

The  old  Egyptians  kept  not  only  human  dwarfs,  but  animal 
dwarfs  also.  On  the  walls  of  the  tombs  of  Beni-Hassan  there  are 
representations  of  dwarf  cattle  and  dogs,  the  latter  resembling 
somewhat  the  dachshund  of  the  present  day  (Plate  IX,  Figs.  18 
and  19). 

A  point  which  as  far  as  I  know  has  escaped  everybody's  attention 
is  that  giants  were  employed  also,  for  in  the  same  tombs  some  men 
are  depicted  who  were  without  doubt  at  least  a  foot  taller  than  their 
fellows.  It  may  be  that  these  men  were  simply  Shillouk  slaves, 
but  at  any  rate  the  point  requires  investigation. 

CONCLUSIONS 

The  statuettes,  bas-reliefs,  and  paintings  found  in  ancient 
Egyptian  tombs  show  that: 

1.  Achondroplasia  has  existed  for  at  least  five  thousand  years. 

2.  Rickets  has  probably  existed  for  the  same  period,  and 
certainly  since  2000  b.c. 

3.  The  deformities  characteristic  of  Pott's  disease  and  of  talipes 
equino-varus  were  put  on  record  about  four  thousand  years  ago. 

4.  In  addition  to  the  deformities  of  the  skeletons  mentioned, 
there  arc  a  number  of  others  to  be  found  on  Egyptian  monuments 
in  which  the  diagnosis  remains  doubtful. 


48  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

DESCRIPTION  OF  PLATES  VII-XI 
(For  particulars  see  text) 
plate  vn 
The  dwarf  Chnoum-Hotep. 

plate  vin 
Achondroplastic  dwarfs. 


Fig.    9. — Female  achondroplastic  dwarf  following  a  young  girl. 

Fig.  10. — A  boy  with  talipes  equino-varus  and  a  rickety  dwarf. 

Fig.  11. — A  boy  with  talipes  equino-varus. 

Fig.  12. — A  rickety  dwarf. 

Fig.  13. — Two  female  dwarfs  with  talipes  equino-varus. 

Fig.  14. — A  hunchback. 

Fig.  15. — Another  hunchback. 

Fig.  16. — A  dwarf.     (Diagnosis?) 

Fig.  18. — Dwarf  bull  led  by  a  man. 

Fig.  19. — Dwarf  dog. 

PLATE  X 

Fig.  1. — Statuette  from  the  Ashmolean  Museum  at  Oxford  representing  a 
female  dwarf.     (Diagnosis  ?) 

Fig.  2. — A  hunchback,  from  Mme  Constantine  Sinadino's  collection 
(Greek  period).  • 

Fig.  3. — A  hunchback.  Terra-cotta  pots  in  the  Alexandria  Museum 
(Greek  period). 

PLATE  XI 

The  Queen  of  Punt.     Bas-relief  from  Deir  el  Bahri. 


PLATE  VII 


PLATE  VIII 


Fig.  1 


Flo.  2   . 


Fig.  3 


FiG. 5. 


r*        WZ 

^W.  5 


Fio   6. 


m 

1     \ 
Fio.  8. 


PLATE  IX 


Fig.  9. 


w 

MJQf 


Fig.  13. 


^ 


Fij.fS 


FtQ.7#. 


Fig.    10- 


~   "X 


\  ) 


-J 


Fig.   14-. 


ns- 


Fy.  16. 


Fi„.    //• 


Fa.   12. 


f 


^ 


fy./X 


PLATE  XI 


'M^K 


W^mm^m 


%     tifim 


5^ 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES 

{Memoires  presentes   a   I'Institut  Egyptien,   Le   Caire,  Tome   VI, 
Fascicule  3  [mars  191 1]) 

INTRODUCTION 

The  diseases  of  ancient  Egyptians  have  been  studied  by  several 
different  methods. 

Philologists  have  translated  a  few  Egyptian  papyri  relating  to 
medical  subjects,  and  the  chief  interest  of  their  studies  lies  in  the 
demonstration  of  the  existence  of  a  medical  literature  and  of  a  fairly 
extensive  pharmacopoeia  at  an  early  period.  These  documents, 
however,  are  not  adequate  for  the  identification  of  diseases  which 
were  fatal  in  olden  times. 

Even  in  the  "Papyrus  Ebers, "  the  most  famous  of  Egyptian 
medical  documents,  the  description  of  symptoms  is  crude,  and, 
although  the  papyrus  contains  some  information  regarding  the 
occurrence  of  intestinal  worms  and  diseases  of  various  organs,  yet 
an  indisputable  diagnosis  of  any  one  disease  in  this  work  is  in  my 
opinion  impracticable. 

The  same  is  partly  true  of  the  Berlin  medical  papyrus1  lately 
edited  and  translated  by  Wreszinsky.  The  veterinary  papyri  dis- 
covered by  Professor  Flinders  Petrie  demonstrate  that  the  old 
Egyptians  cultivated  veterinary  as  well  as  human  medicine. 

Another  source  of  information  regarding  ancient  Egyptian 
pathology  is  found  in  the  pictures  and  statues  representing  mal- 
formed persons  which  have  been  discovered  in  many  places.  Egyp- 
tian temples  and  tombs  contain  likenesses  of  people  with  club-foot 
(tombs  of  Beni-Hassan),  rickets  (Kasr-el-Nil  Museum),  steato- 
pygia  (Ashmolean  Museum).  Pictures  and  statuettes  of  malformed 
persons,  e.g.,  dwarfs,  are  common  in  some  of  the  oldest  tombs  of 
Egypt,  in  those  dating  from  the  Greek  period  and  the  Roman 
occupation.  I  have  seen  figures  of  typical  hunchbacks  and  several 
of  men  with  cutaneous  cysts  (private  collection). 

'  The  description  of  facial  paralysis  in  this  papyrus  is  excellent. 


50  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  evidence  from  historical  works  of  comparatively  modern 
times  is  of  little  service,  because,  as  a  rule,  the  symptoms  noted  are 
indicative  not  of  one  disease,  but  of  several.  To  take  an  example 
of  comparatively  recent  times,  the  epidemic  which  devasted  Athens 
and  was  graphically  described  by  Thucydides,  has  been  identified 
according  to  the  diverse  tastes  of  medical  and  other  commentators 
as  black  typhus,  smallpox,  yellow  fever,  cerebro-spinal  meningitis, 
scarlet  fever,  influenza,  and  ergotism  complicated  with  typhus. 

Very  precious  information  has  been  obtained  by  the  examina- 
tion of  skeletons.  Lately  a  new  stimulus  has  been  given  to  this 
hitherto  neglected  branch  of  Egyptology,  by  the  description  by 
Professor  Elliot  Smith,  Dr.  Wood  Jones,  and  Dr.  Derry,  of  bones 
found  in  the  Nile  Valley  above  Assuan.  Unfortunately,  the 
inspection  of  skeletons  reveals  only  the  few  maladies  which  cause 
osseous  lesions,  whereas  many  diseases  leave  no  traces  on  the 
bones. 

The  result  of  the  macroscopical  examination  of  mummified 
organs  is  unsatisfactory  also,  as,  in  the  process  of  drying,  the  soft 
parts  shrank  and  are  therefore  so  changed  as  to  render  pathological 
lesions  unrecognisable  (see  Plates  XII,  XIII,  XIV).  Still,  this 
method  may  give  noteworthy  results,  and  Professor  Elliot  Smith, 
for  instance,  showed  me  a  gall-bladder  which  undoubtedly  contained 
biliary  calculi. 

One  other  available  method  consists  in  the  microscopical  exami- 
nation of  mummies,  which,  as  far  as  I  know,  has  never  been  applied 
systematically.  Histologists  were  probably  repelled  by  the  very 
unpromising  appearance  of  the  material.  It  is  not  easy  to  say,  for 
instance,  to  what  organ  some  of  the  brownish,  dry,  hard  fragments 
found  in  the  body  cavity  belong.  A  provisional  diagnosis,  as  I  have 
found  to  my  cost,  not  infrequently  proves  incorrect.  I  am  in- 
formed, however,  that  Professor  Looss  demonstrated  the  striation 
of  mummified  muscles  to  his  colleagues,  but  I  am  not  aware  of  any 
systematic  work  on  the  histological  examination  of  mummies. 

It  appeared  to  me  that  if,  by  any  process,  the  flexibility  and 
original  shape  of  the  mummified  tissues  were  restored,  their  micro- 
scopical structure  would  be  recovered  also,  partially  at  least,  and 
that  pathological  alterations  might  then  possibly  be  demonstrated. 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES  51 

This  paper,  however,  is  concerned  with  the  first  two  questions 
only,  viz.,  the  restoration  of  mummified  tissues  to  their  original  size 
and  the  recovery  of  their  microscopical  appearance. 

For  the  material  necessary  for  this  work  I  am  indebted  in  the 
first  instance  to  Professor  Elliot  Smith.  I  obtained  also  very  valu- 
able specimens  from  Professor  Flinders  Petrie,  Sir  Gaston  Maspero, 
and  from  Dr.  Keatinge.  I  take  this  opportunity  of  thanking  all 
these  gentlemen  for  their  help,  as  also  Mr.  A.  Cooper  for  many  of 
the  illustrations  and  Mrs.  Alice  Mary  Ruffer  for  most  of  the  paint- 
ings of  microscopical  specimens  accompanying  this  paper. 

METHODS   OF   EMBALMING 

I  do  not  intend  to  give  here  a  full  account  of  the  various  methods 
of  embalming  in  successive  dynasties,  as  a  volume  would  be  required 
for  that  purpose.  It  is  extraordinary  that,  as  far  as  I  know,  no 
such  work  exists  and  a  full  account  has  not  been  written  of  the  meth- 
ods of  embalming  the  bodies  discovered  in  the  many  tombs  opened 
lately.  Indeed,  most  of  the  writers  on  this  subject  are  content  to 
copy  the  accounts  given  by  Herodotus  and  by  Diodorus  Siculus. 

Herodotus'1  description  is  as  follows: 

There  are  certain  individuals  appointed  for  the  purpose  [embalming],  and 
who  profess  that  art;  these  persons  after  any  body  is  brought  to  them,  show 
the  bearers  some  good  models  of  corpses,  painted  to  represent  the  originals; 
the  most  perfect  they  assert  to  be  the  representation  of  him  whose  name  I  take 
it  to  be  impious  to  mention  in  this  matter;  then  they  show  a  second  which  is 
inferior  to  the  first,  and  cheaper;  and  a  third,  which  is  cheapest  of  all.  They 
then  ask  of  them  according  to  which  of  the  models  they  will  have  the  deceased 
prepared:  having  settled  upon  the  price,  the  relations  immediately  depart, 
and  the  embalmers,  remaining  home,  thus  proceed  to  perform  the  embalming 
in  the  most  costly  manner.  In  the  first  place,  with  a  crooked  piece  of  iron, 
they  pull  out  the  brain  by  the  nostrils;  a  part  of  it  they  extract  in  this  manner, 
the  rest  by  means  of  pouring  in  certain  drugs:  in  the  next  place,  after  making 
an  incision  in  the  flank  with  a  sharp  Egyptian  stone,  they  empty  the  whole  of 
the  inside;  and  after  cleansing  the  cavity,  and  rinsing  it  with  palm  wine,  scour 
it  out  again  with  pounded  aromatics :  then  having  filled  the  belly  with  pure  myrrh 
pounded,  and  cinnamon,  and  all  other  perfumes,  frankincence  excepted,  they 
sew  it  up  again;  having  so  done,  they  steep  the  body  in  natrum,2  keeping  it 
covered  for  70  days,  for  it  is  not  lawful  to  leave  the  body  any  longer  in  the 

1  This  is  copied  from  Pettigrew.  >  Pettigrew  wrote  natrum. 


52  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

brine.  When  the  70  days  are  gone  by,  they  first  wash  the  corpse,  and  then 
wrap  up  the  whole  of  the  body  in  bandages  cut  out  of  cotton  cloth,  which  they 
smear  with  gum,  a  substance  the  Egyptians  generally  use  instead  of  paste. 

The  relations,  having  then  received  back  the  body,  get  a  wooden  case,  in 
the  shape  of  a  man ,  to  be  made ;  and,  when  completed,  place  the  body  in  the 
inside;  and  then,  shutting  it  up,  keep  it  in  a  sepulchral  repository,  where  they 
stick  it  upright  against  the  wall.  The  above  is  the  most  costly  manner  in 
which  they  prepare  the  dead.  For  such  as  choose  the  middle  mode,  from  a 
desire  of  avoiding  expense,  they  prepare  the  body  thus :  they  first  fill  syringes 
with  cedar  oil,  which  they  inject  into  the  belly  of  the  deceased,  without  making 
any  incision,  or  emptying  the  inside,  but  sending  it  up  by  the  seat;  they  then 
close  the  aperture,  to  hinder  the  injection  from  flowing  backwards,  and  lay  the 
body  in  brine  for  the  specified  number  of  days,  on  the  last  of  which  they  take  out 
the  cedar  oil  which  they  have  previously  injected,  and  such  is  the  strength  it  pos- 
sesses that  it  brings  away  with  it  the  bowels  and  inside  in  a  state  of  dissolution: 
on  the  other  hand,  the  natrum  dissolves  the  flesh,  so  that,  in  fact,  there  remains 
nothing  but  the  skin  and  the  bones;  when  having  so  done,  they  give  back  the 
body  without  performing  any  further  operation  upon  it. 

The  third  mode  of  embalming,  which  is  used  for  such  as  have  but  scanty 
means,  is  as  follows:  after  washing  the  inside  with  syrmaea,  they  salt  the  body 
for  the  70  days,  and  return  it  to  be  taken  back.  The  wives  of  men  of  quality 
are  not  given  to  be  embalmed  immediately  after  their  death,  neither  are  those 
that  may  have  been  extremely  beautiful,  or  much  celebrated;  but  they  deliver 
them  to  the  embalmers  after  having  been  3  or  4  days  deceased:  this  they  do 
for  the  following  reason,  that  the  workmen  may  not  be  able  to  abuse  the  bodies 
of  these  females;  for  it  is  reported  by  them,  that  one  of  these  artificers  was 
discovered  in  the  very  act  on  the  newly-deceased  body  of  a  woman,  and  was 
impeached  by  his  fellow  workman. 

Diodorus  Siculus  wrote  as  follows  on  the  same  subject: 

When  anyone  amongst  the  Egyptians  dies,  all  his  relations  and  friends, 
putting  dirt  upon  their  heads,  go  lamenting  about  the  city  till  such  time  as 
the  body  shah  be  buried.  In  the  meantime  they  abstain  from  baths  and  wine, 
and  all  kinds  of  delicate  meats,  neither  do  they  during  that  time  wear  any 
costly  apparel.  The  manner  of  tneir  burial  is  threefold;  one  very  costly,  the 
second  sort  less  chargeable,  and  the  third  very  mean.  In  the  first,  they  say 
there  is  spent  a  talent  of  silver,  in  the  second  20  minae,  but  in  the  last  there  is 
very  little  expense.  Those  who  have  the  care  of  ordering  the  body  are  such  as 
have  been  taught  that  art  by  their  ancestors.  These,  showing  to  the  kindred 
of  the  deceased  a  bill  of  expenses  of  each  kind  of  burial,  ask  them  after  what 
manner  they  will  have  the  body  prepared;  when  they  have  agreed  upon  the 
matter,  they  deliver  the  body  to  such  as  are  usually  appointed  for  this  office. 
First,  he  who  has  the  name  of  scribe,  laying  it  upon  the  ground,  marks  about 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         53 

the  flank  on  the  left  side  how  much  is  to  be  cut  away.  Then  he  who  is  called 
the  cutter  or  the  dissector,  with  an  Ethiopic  stone  cuts  away  as  much  of  the 
flesh  as  the  law  commands,  and  presently  runs  away  as  fast  as  he  can:  those 
who  are  present,  pursuing  him,  cast  stones  at  him,  and  curse  him,  hereby  turn- 
ing all  the  execrations  which  they  imagine  due  to  his  office,  upon  him.  For, 
whosoever  offers  violence,  wounds,  or  does  any  kind  of  injury  to  a  body  of  the 
same  nature  with  himself,  they  think  him  worthy  of  hatred;  but  those  who  are 
called  the  embalmers  they  esteem  worthy  of  honour  and  respect;  for  they  are 
familiar  with  their  priests  and  go  into  the  temples  as  holy  men,  without  any 
prohibition.  So  soon  as  they  come  to  embalm  the  dissected  body,  one  of  them 
thrusts  his  hand  through  the  wound  into  the  abdomen,  and  draws  forth  all  the 
bowels  but  the  heart  and  kidneys,  which  another  washes  and  cleanses  with 
wine  made  of  palms  and  aromatic  odours;  lastly,  having  washed  the  body, 
they  anoint  it  with  oil  of  cedar  and  other  things  for  above  thirty  days,  and 
afterwards  with  myrrh,  cinnamon,  and  other  such  like  matters,  which  have 
not  only  a  power  to  preserve  it  for  a  long  time,  but  also  give  it  a  sweet  smell; 
after  which  they  deliver  it  to  the  kindred,  in  such  manner  that  every  member 
remains  whole  and  entire,  and  no  part  of  it  changed,  but  the  beauty  and  shape 
of  the  face  seems  just  as  it  was  before,  and  may  be  known,  even  the  hairs  of 
the  eye-lids  and  eye-brows  remaining  as  they  were  at  first.  By  this  means 
many  of  the  Egyptians,  keeping  the  dead  bodies  of  their  ancestors  in  mag- 
nificent houses,  so  perfectly  see  the  true  visage  and  countenance  of  those  that 
died  many  ages  before  they  themselves  were  born,  that  in  viewing  the  pro- 
portions of  every  one  of  them,  and  the  lineaments  of  their  faces,  they  take  as 
much  delight  as  if  they  were  still  living  among  them. 

The  importance  of  these  two  classical  accounts  of  the  process  of 
embalming  must  not  be  overrated.  Herodotus  died  406  B.C.,  and 
Diodorus  Siculus  440  years  afterwards.  Their  descriptions,  there- 
fore, though  possibly  true  for  their  epoch,  may  not  represent 
accurately  the  practice  followed  during  the  thousand  preceding 
years  or  so,  when  embalming  was  a  common  practice. 

The  same  criticism  holds  good  for  all  the  old  descriptions.  The 
only  way  to  obtain  information  with  regard  to  embalming  processes, 
therefore,  is  to  dissect  the  mummies  of  various  dynasties.  Such 
an  attempt  was  made  by  Pettigrew1  who  gave  a  somewhat  incom- 
plete resume  of  the  literature  and  of  the  facts  known  at  his  time, 
and  carefully  described  some  of  the  mummies  he  had  studied. 

1  A  History  of  Egyptian  Mummies  and  an  Account  of  the  Worship  and  Embalming 
of  the  Sacred  A  nimals  by  Egyptians,  with  remarks  on  the  funeral  ceremonies  of  different 
and  observations  on  the  mummies  of  the  Canary  Islands,  of  the  ancient 
0  ,  Burman  |.ri<  .1 5,  <  l<  .,  London,  1834. 


54  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

More  lately  two  papers  on  the  subject  have  appeared :  the  first 
by  Dr.  Fouquet1  and  the  other  by  Professor  Elliot  Smith.2 

The  two  memoirs  are  based  on  the  study  of  mummies  of  the 
priests  and  priestesses  of  Anion  found  at  Deir  el  Bahri  and  dating 
from  the  XXIst  Dynasty  (iooo  B.C.),  and  as  most  of  my  specimens 
come  from  these  same  mummies,  I  must  enter  more  fully  into  the 
work  of  these  observers. 

Dr.  Fouquet  states  that  such  a  mummy  when  unrolled  is  found 
to  be  enclosed  in  two  layers  of  bitumen.  The  legs  are  extended, 
the  arms  brought  alongside  the  body  or  slightly  crossed  at  the  pubis. 
The  skin  is  everywhere  smooth  and  clean,  absolutely  shaved,  except 
for  the  hairs  of  the  head,  the  eyebrows,  and  the  eyelashes.  The 
mouth,  the  nostrils,  the  eyes,  and  the  ears  are  covered  with  a  layer 
of  virgin  wax  closely  applied  and  with  resin  of  cedar  under  the  wax. 
The  closed  mouth  conceals  the  teeth,  the  lips  are  painted  red,  the 
eyebrows  are  painted  also,  and  the  eyelids  are  often  adorned  with 
kohl.  The  face,  hands,  feet,  and  sometimes  even  the  whole  body 
are  painted.  The  body  itself  has  sometimes  kept  to  some  extent 
the  well-nourished  appearance  it  had  during  life,  the  breasts  alone 
of  women  are  flattened  and  closely  applied  to  the  thorax.  The 
neck,  comparatively  thin,  looks  even  thinner  on  account  of  the  face, 
which  is  artificially  distended. 

I  have  no  doubt  that  the  account  given  by  Dr.  Fouquet  is  correct 
as  far  as  the  mummies  examined  by  him  are  concerned.  In  the 
fragments  of  the  five  mummies  which  Professor  Flinders  Petrie  gave 
me,  dating  from  some  period  between  the  XVIIIth  and  XX th 
Dynasties,  and  in  numerous  mummies  of  the  XXIst  Dynasty,  I  was 
not  able  to  find  the  slightest  trace  of  bitumen  on  the  surface  of  the 
bodies,  but  the  abdominal  walls  were  covered  by  a  thick  layer  of 
what  looked  like  resin.  Similarly,  Dr.  Elliot  Smith  says  nothing 
about  bitumen.3     The  female  bodies  that  he  examined  were  painted 

1  Note  pour  servir  d  Vhistoire  de  I'embamnemcnt  en  Egypte,  communication  faite  a 
l'Institut  Egyptien  dans  la  seance  du  6  mars  1896,  Le  Caire,  1896. 

2  "A  Contribution  to  the  State  of  Mummification  in  Egypt,"  with  special  refer- 
ence to  the  measures  adopted  during  the  time  of  the  XXIst  Dynasty  for  moulding 
the  form  of  the  body,  Memoires  prescntesd  l'Institut  Egyptien  (publies  sous  les  auspices 
de  S.  A.  Abbas  II,  Khedive  d'Egypte),  Cairo,  1906. 

3  It  is  a  peculiar  fact  that  I  have  never  yet  found  bitumen  in  any  mummy,  and  my 
experience  now  extends  from  prehistoric  to  Coptic  times  (March,  191 1). 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES  55 

with  a  mixture  identified  by  Dr.  Schmidt  as  yellow  ochre  and  gum. 
The  bodies  of  the  men  were  painted  either  red,  rose-coloured,  or 
more  usually  a  dull  reddish  or  yellowish  brown.  This,  judging 
from  my  own  observations,  is  quite  correct. 

I  discovered  no  trace  of  paint  in  mummies  of  later  periods,  nor 
in  a  Greek  ( ?)  mummy,  but  the  face,  though  not  the  body  of  a 
Roman  child,  was  gilded  all  over  (see  also  Pettigrew,  loc.  cit.). 

According  to  Dr.  Fouquet,  a  ball  made  of  rag,  on  which  the  iris 
was  roughly  painted,  was  placed  under  the  half-closed  eyelids. 
I  have  confirmed  this  observation  in  one  case. 

In  another  body  of  which  I  examined  the  eyes  there  was  not  a 
trace  of  rag.  The  eyeballs  had  disappeared,  but  the  pedicles  of  the 
eyes  (muscles)  were  still  to  be  seen.  In  another,  two  artificial  eyes 
had  been  inserted. 

Professor  Elliot  Smith  states  that  during  the  preliminary  stages 
of  embalming,  the  eyes  collapsed  and  fell  back  into  the  orbits. 
Artificial  eyes  were  then  introduced  in  front  of  the  remains  of  the 
real  eyes,  and  the  eyelids  puUed  down  into  a  semi-closed  position. 
The  artificial  eye  usually  consisted  of  a  piece  of  linen  rolled  up 
roughly;  the  pupil  is  represented  by  a  spot  of  black  paint;  in  two 
cases  the  eye  was  represented  by  a  piece  of  white  stone  with  a  black 
spot  on  it.  In  the  mummy  of  Ramses  IV,  small  onions  were  put 
in  front  of  the  collapsed  eyes. 

In  two  mummies  of  the  XXVIIth-XXIXth  Dynasties  which 
I  examined  the  eyeballs  had  shrunk  greatly,  but  the  eyes  were 
uninjured,  and  the  contents  of  the  orbit  had  not  been  interfered 
with.  The  eyelashes  were  perfect.  In  a  Roman  child  and  in  a 
Greek  (  ?)  mummy  nothing  appeared  to  have  been  done  to  the  eyes. 
The  orbits  certainly  contained  no  foreign  matter  whatever. 

I  also  examined  the  eyes  of  several  bodies  of  the  Greek  period, 
which  had  simply  been  buried  in  the  sand.  The  eyeballs  could  not 
be  recognised.  On  the  other  hand,  all  the  muscles  were  unmistak- 
able and  the  transverse  striation  easily  demonstrated.  The  optic 
nerves  were  visible;  unfortunately  their  microscopical  structure 
was  greatly  altered  by  an  enormous  growth  of  moulds. 

\>r.  Fouquet  states  that  some  of  the  tissues  and  bandages  which 
touched  the  bodies  were  examined  by  Professor  Lacassagne  and 


56  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

that  he  obtained  the  characteristic  reaction  of  haemoglobin.     On 
the  other  hand,  Professor  Elliot  Smith  writes : 

No  one  has  a  greater  knowledge  of  all  the  most  modern  tests,  chemical  and 
biological,  for  blood-stains,  nor  a  better  acquaintance  with  those  methods  in 
medico-legal  practice  than  my  colleague  Prof.  Schmidt  of  the  Cairo  School 
of  Medicine.  Dr.  Schmidt  has  examined  large  numbers  of  pieces  of  stained 
cloth  and  pieces  of  highly  vascular  tissues  from  a  large  series  of  mummies;  he 
tells  me  that  he  has  been  utterly  unable  to  recognise  the  presence  of  haemo- 
globin, although  the  tests  in  use  now  are  immeasurably  more  delicate  and  sure 
than  those  used  10  years  ago.  All  the  reddish  stains  on  linen  were  found  to 
be  due  to  resin. 

I  can  only  agree  with  Professor  Elliot  Smith  and  Professor 
Schmidt.  I  have  repeatedly  tried  to  get  blood  reactions  from 
tissues  of  mummies,  but  always  unsuccessfully.  Although  I  have 
examined  many  hundred  specimens,  I  have  never  demonstrated 
undoubted  red  blood  corpuscles.  In  one  case  only  did  I  see  some 
brownish  bodies  which  certainly  resembled  red  blood  corpuscles, 
but  I  could  not  identify  even  them  with  certainty. 

METHODS   OF   PRESERVING   THE   DEAD 

We  may  now  give  a  general  account  of  the  treatment  to  which 
the  body  cavities  and  the  viscera  were  subjected  after  death. 

I  shall  limit  myself  almost  wholly  to  the  method  of  embalming 
which  was  used  during  the  XXIst  Dynasty,  and  hence,  I  cannot  do 
better  than  follow  closely  the  account  given  by  Professor  Elliot 
Smith. 

The  price  having  been  agreed  upon,  the  embalmers  took  charge 
of  the  body,  and,  as  the  process  is  supposed  to  have  taken  at  least 
seventy-two  days  to  carry  out,  the  body  was  probably  carried  to 
some  special  laboratory  fitted  for  the  purpose. 

Considering  the  delay  which  must  have  ensued  while  the  bargain 
was  made  and  the  body  carried  to  the  laboratory,  it  is  not  improb- 
able that,  in  the  majority  of  cases,  several  hours  elapsed  from  the 
time  of  death  to  that  of  the  first  incision. 

The  embalming  incision  usually  caused  a  large,  vertical,  fusi- 
form, gaping  wound  in  the  left  lumbar  region,  extending  from  the 
iliac  crest,  about  2-3  cm.  behind  the  anterior  superior  iliac  spine, 
to  the  costal  margin. 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES  57 

It  may  be  further  forward,  or  extend  lower  down  in  front  of  the 
iliac  spine.  As  a  rule,  no  attempt  was  made  to  close  the  wound, 
which  was  then  covered  with  a  plate,  usually  of  wax,  but  some- 
times of  bronze,  bearing  the  conventional  sign  of  the  eye  or  Uta. 
In  some  cases,  the  gaping  wound  was  not  protected  by  a  plate 
of  any  sort;  and  in  two  cases  examined  by  Professor  Elliot  Smith 
the  edges  were  brought  together  and  kept  in  position  by  a  running 
ligature. 

In  one  mummy  that  I  dissected  the  wound  was  firmly  closed  by 
a  linen  plug  which  must  have  been  rammed  in  with  considerable 
force,  after  the  body  had  been  well  filled  with  earth. 

The  body  cavity  having  thus  been  opened,  the  intestines,  liver, 
spleen,  kidneys,  stomach,  pelvic  viscera,  and  most  of  the  vessels 
were  completely  removed.  The  diaphragm  having  been  been  cut 
through,  the  lungs  were  freed  by  severing  the  bronchi,  or,  in  some 
cases,  the  lower  end  of  the  trachea. 

The  heart  was  left  in  the  body  but  never  exactly  in  the  normal 
position.  Generally  it  was  pushed  upwards  into  the  upper  part  of 
the  right  side  of  the  thorax;  sometimes  it  was  left  in  the  middle  line 
in  front  of  the  vertebral  column,  or  again,  it  is  found  in  the  left  side 
of  the  chest. 

In  one  mummy  which  I  examined  the  heart  had  been  removed  by 
the  embalmer.  It  had  not  been  replaced  in  its  proper  position, 
however,  for  both  kidneys  filled  the  pericardium.  Behind  the  liver 
there  was  a  packet  containing  striped  muscular  fibre,  which  was 
probably  the  heart. 

Sometimes  only  the  arch  and  a  small  part  of  the  aorta  were  left 
behind,  but  in  one  body  Professor  Elliot  Smith  found  the  whole 
aorta  and  iliac  arteries.  I  also  dissected  out  the  whole  of  the  aorta 
(except  the  transverse  part),  together  with  the  iliac  arteries,  of  one 
mummy. 

After  the  viscera  had  been  removed,  both  the  body  and  the 
organs  were  put  into  the  saline  bath  described  by  Herodotus.  The 
various  tissues  of  the  body  and  the  organs  contain  saline  material 
and  the  skin  shows  unmistakable  signs  of  having  been  macerated 
until  all  the  cuticle,  together  with  the  hair,  except  that  of  the  head, 
harl  peeled  off.     There  are  certainly  exceptions  to  this  rule,  as  in 


58  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

some  cases  I  have  found  the  epidermic  cells  intact  and  even  their 
nuclei  stained  well. 

The  heart  left  in  the  body  cavity  is  always  well  preserved.  In 
many  cases  the  valves  are  intact  and  it  is  often  possible  to  recognise 
the  chordae  tendineae  and  musculi  papillares.  As  a  rule,  the  organ 
is  considerably  damaged,  as  the  result  no  doubt  of  unintentional 
hackings  inflicted  on  it  by  the  operator  cutting  through  the  roots 
of  the  lungs  and  the  oesophagus  (Plate  XIV,  Figs.  2  and  3).  The 
commonest  injury  to  the  heart  is,  as  is  natural,  a  complete  opening 
of  the  left  auricle,  or  often  of  both  auricles;  in  many  cases  great 
gashes  are  found  in  one  or  both  ventricles. 

The  cavities  of  the  heart  are  in  many  subjects  tightly  stuffed 
with  mud  or  a  mixture  of  mud  and  sawdust.  How  this  material 
was  introduced  is  doubtful. 

The  viscera,  after  having  been  removed  from  the  salt  bath,  were 
thickly  sprinkled  with  coarse  sawdust  of  various  aromatic  woods, 
and  when  still  flexible  were  moulded  into  shape  and  wrapped  in 
linen.  This  must  have  been  done  before  desiccation,  as  one  end  of 
the  linen  bandage  is  almost  always  interwined  with — and  so  fixed 
to — some  part  of  the  organ.  The  small  intestines  are  usually  bent 
upon  themselves  many  times  so  as  to  form  an  elongated  parcel  of 
parallel  bands. 

Among  these  bands  there  was  placed  (when  the  viscus  was  still 
flexible)  a  wax  image  of  one  of  the  four  genii,  usually  the  hawk- 
headed  Khebsennuf.  Then,  after  being  sprinkled  with  sawdust, 
the  mass  was  wrapped  in  the  linen  bandage. 

The  liver  is  usually  flexed  round  its  transverse  axis,  so  as  to  form 
a  hollow  tube  open  on  one  side,  and  either  the  upper  or  lower  surface 
may  form  the  surface  of  the  tubular  cylinder.  Inside  the  cylinder 
thus  prepared  a  wax  statuette,  usually  the  human  headed  Amset, 
is  found  in  most  cases.  In  other  respects  the  liver  was  treated 
exactly  like  the  intestines.  It  would  appear,  however,  that  in  many 
cases  the  embalmer  was  unable  to  remove  or  reintroduce  the  liver 
without  tearing  it.  In  such  cases  he  was  content  to  replace  only 
a  fragment  of  the  organ  into  the  body  (see  further  on). 

Although  either  of  these  parcels  may  be  found  in  any  part  of  the 
body  cavity,  yet  in  the  majority  of  subjects  they  occupy  definite 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         59 

situations.  The  parcel  of  intestines  is  placed  vertically  in  the  abdo- 
men against  the  right  wall  and  extends  from  the  iliac  fossa  to  the 
right  costal  margin,  and  the  liver  lies  transversely  in  the  lower  part 
of  the  thorax. 

After  the  various  parcels  of  the  viscera  had  been  returned  to  the 
body  and  had  been  packed  tightly  in  sawdust  or  coarser  fragments 
of  wood,  a  large  part  of  the  abdomen  and  pelvis  still  remained 
comparatively  empty.  This  region  was  then  tightly  stuffed  with 
sawdust,  and  the  opening  in  the  left  flank  was  subsequently  closed. 

The  genital  organs  of  women  are  always  absent,  the  labia  majora 
being  the  only  parts  of  the  vulva  left.  In  only  two  or  three  cases 
the  remains  of  the  pudenda  and  the  labia  majora  were  left  in  their 
natural  position.  In  most  cases,  the  skin,  while  still  soft  and 
flexible,  had  been  pushed  back  towards  the  anus,  so  as  to  form  an 
apron  covering  the  rima  pudendi. 

The  bladder,  according  to  Elliot  Smith,  is  sometimes  in  situ. 

The  penis  and  scrotum  were  painted  red  like  other  parts  of  the 
body,  and  as  a  rule  were  wrapped  separately  from  the  limbs.  In 
some  cases  the  genital  organs  were  pushed  against  one  or  the  other 
thigh  and  wrapped  with  the  limbs.  In  one  case  the  penis  was  flat- 
tened against  the  perineum,  so  that,  at  a  casual  glance,  the  organ 
seemed  to  be  missing.  In  several  subjects,  male  and  female,  the 
pubic  region  was  packed  either  with  cloth  or  with  mud. 

When  the  viscera  were  returned  to  the  body  cavity,  it  was 
customary  to  place,  along  with  some  of  the  organs,  certain  wax  or 
pottery  models  of  the  children  of  Horus.  Details  regarding  this 
custom  are  contained  in  Elliot  Smith's  papers,  and  it  will  be  suf- 
ficient to  say  that  besides  the  human-headed  Amset  generally  found 
wrapped  up  in  the  liver,  the  hawk-headed  Khebsennuf  with  the 
intestines,  the  ape-headed  Api  is  usually  associated  with  the  left 
lung,  and  the  jackal  Tuamautef  with  the  stomach. 

Flowers  and  other  vegetable  substances,  especially  onions,  are 
often  found  among  the  wrappings,  on  the  surface  of  the  body  or 
inside  the  mummy. 

Elliot  Smith  says  that  the  saline  bath  toughened  the  skin  and 
the  lining  of  the  cavity,  but  the  underlying  tissues  in  the  limbs, 
back,  or  neck  were  not  exposed  to  the  action  of  the  preservative 


60  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

agent,  and  were  soon  reduced  to  a  soft  pulpy  mass,  of  fluid  or  semi- 
fluid consistency.  It  was  the  custom  to  stuff  into  this  pulpy  mass 
large  quantities  of  foreign  material,  so  as  to  restore  to  the  collapsed 
and  shrunken  members  some  semblance  of  the  form  and  consistency 
they  possessed  during  life.  The  foreign  material  varied  a  good 
deal,  the  ingredients  chiefly  used  being  mud,  linen  bandages,  a  mix- 
ture of  mud  and  sawdust,  or  a  mixture  of  soda  and  butter.  The 
ways  in  which  this  material  was  introduced  and  the  body  packed 
have  been  fully  described  in  Professor  Elliot  Smith's  paper. 

The  description  of  the  packing  is  of  course  perfectly  correct,  but 
I  must  point  out  that  there  is  no  proof  that  the  tissues  were  changed 
into  a  soft,  pulpy  mass.  I  have  examined  several  mummies,  the 
limbs  of  which  had  not  been  packed  by  the  embalmer,  and  I  found 
the  muscles,  nerves,  arteries,  etc.,  in  a  very  good  state  of  preserva- 
tion.    Indeed,  most  of  the  histological  details  were  plainly  visible. 

A  good  deal  of  interest  attaches  to  the  "natron"  bath  in  which 
the  bodies  were  immersed  for  seventy  days,  and  some  controversy 
has  taken  place  with  regard  to  its  chemical  constitution.  Analyses 
of  the  mineral  salts  from  mummies  have  given  but  doubtful  results. 

According  to  Mr.  A.  Lucas,  the  inorganic  substances  used  by 
embalmers  were  essentially  of  two  kinds:  namely  "natron"  and 
common  salt.  Natron  is  the  natural  soda  found  in  Egypt,  chiefly 
in  the  Wady  Natroun,  and  is  essentially  a  mixture  of  sodium  carbon- 
ate, sodium  chloride,  and  sodium  sulphate  in  varying  proportions. 
It  contains  also  a  certain  amount  of  clay  and  calcium  carbonate. 
Mr.  Lucas  found  that  of  two  samples  of  natron  discovered  in  Cano- 
pic  jars  in  the  tomb  of  Iaa  at  Thebes,  one  was  crude  natron  of  pure 
quality,  such  as  occurs  in  many  parts  of  Egypt,  and  the  other  a 
mixture  of  crude  natron  and  coarse  sawdust.  Several  other  observ- 
ers have  found  natron  in  the  bodies  of  wrappings  of  mummies. 
The  resinous  material  from  mummies  also  contains  a  large  amount 
of  natron. 

On  the  other  hand,  Professor  Schmidt  of  Cairo  is  of  opinion  that 
the  inorganic  material  used  for  packing  was  not  natron  but  common 
salt.     His  results  may  be  summed  up  as  follows : 

Mummies  contain  volatile  and  nonvolatile  fatty  acids,  albumi- 
nous substances,  cholesterin,  and  traces  of  unaltered  fat.     Specific 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         6 1 

human  antisera  (whether  obtained  by  the  injection  of  blood  or 
muscular  tissue)  produce  no  precipitate  in  mummy  tissue.  The 
presence  of  haemoglobin  cannot  be  demonstrated  by  any  method. 

He  does  not  deny  that  natron  was  used,  but  considers  that  it 
was  only  used  for  packing,  as,  for  instance,  in  the  mouth,  and  in 
that  case  it  was  mixed  with  fat,  e.g.,  butter  to  form  a  paste. 

He  maintains  that  the  fatty  acids  are  derived  not  from  the  fat 
of  the  body  only,  but  from  the  albuminous  material,  and  that  during 
mummification  fixed  fatty  acids  were  formed  which,  later  on,  were 
converted  into  volatile  fatty  acids.  He  bases  this  hypothesis  on  the 
fact  that  the  older  the  mummy,  the  greater  the  amount  of  volatile 
fatty  acids  as  compared  with  the  quantity  of  fixed  fatty  acids. 

Schmidt  found  a  large  quantity  of  higher  fatty  acids  in  the  natron 
used  for  packing.  He  is  of  opinion  that  the  volatile  acids  present 
in  this  natron  were  not  due  to  the  decomposition  of  some  fat  added, 
but  originated  in  the  body  fat  and  tissues.  He  has  found,  for 
instance,  the  higher  fatty  acids  in  the  spleen  and  liver,  which  had 
never  been  in  contact  with  natron. 

Schmidt  summed  up  his  opinion  as  follows : 

We  see  that  the  old  Egyptians  worked  with  very  simple  methods.  The 
following  are  the  only  important  parts  of  their  process:  ist:  removal  of  the 
most  easily  putrescible  viscera,  2nd:  the  salt  bath,  3rd:  thorough  drying  of 
the  corpse  in  the  air,  and  4th:   the  rolling  of  the  body  in  bandages. 

Modern  researches  on  the  microscopical  changes  taking  place 
in  putrefying  or  mummifying  tissues  help  us  very  little,  for  the 
microscopical  appearance  of  putrefying  organs  has  not  been  the 
subject  of  many  careful  investigations. 

The  appearance  of  putrefaction  in  nervous  tissue  shows  itself 
first  in  the  axis  cylinder  and  nerve  fibres,  which  break  up  into  frag- 
ments. The  nervous  cells  of  cerebral  and  peripheral  ganglia  resist 
for  a  long  time. 

In  the  lungs,  the  epithelial  lining  of  the  alveoli  and  bronchi  is 
first  affected.  This  is  loosened  and  finally  disappears  totally.  The 
elastic  tissue  long  remains  unaltered. 

The  epithelium  cells  of  the  liver,  kidneys,  and  stomach  become 

opaque  and  lose  their  nuclei.     The  epithelium  cells  of  the  kidney — 

iallj  those  of  the  contorti — fall  off,  and  chronic  nephritis  may 


62  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

then  be  simulated.  The  connective  tissues  of  all  organs  keep  their 
nuclei  longer  than  the  epithelium  cells.  ■ 

The  unstriated  muscular  fibres  retain  their  characteristic  appear- 
ance for  a  long  time,  and  so  do  the  striated  muscular  fibres  which 
lose  their  striation  only  slowly.  The  heart  fibres  show  their  charac- 
teristic arrangement,  and  the  structure  of  kidney  and  liver  is  no 
longer  recognisable. 

The  state  of  the  stomach  gives  no  valuable  information,  as 
self-digestion  varies  considerably. 

It  is  stated  that  in  contradiction  to  putrefying  organs,  dried 
(mummified)  tissues  retain  their  characteristic  structure  for  a  much 
more  extended  period. 

ON   THE   FORMATION   OF   ADIPOCERE  (  ?)    IN   MUMMIFIED    ORGANS 

I  attempted  to  soften  entire  organs  of  mummies  of  the  XXIst 
Dynasty  by  placing  them  in  a  solution  of  i  per  cent  formol,  contain- 
ing i  per  cent  carbonate  of  soda.  Some  organs,  e.g.,  lungs,  swell 
up  considerably,  and  their  characteristic  spongy  structure  becomes 
evident.  The  liver  never  swells  up  to  any  extent,  whereas  the 
kidneys  become  considerably  larger  and  softer.  When  the  carbon- 
ate of  soda-formol  solution  extracts  no  more  colouring  matter,  it  is 
replaced  by  a  5  per  cent  solution  of  formol,  in  which  the  organs  may 
remain  indefinitely. 

Not  infrequently  a  curious  change  is  observed  to  have  taken 
place,  especially  in  the  lungs.  After  the  mud  and  vegetable  matter 
have  fallen  to  the  bottom  or  floated  off,  the  organ,  or  part  of  it,  is 
found  to  be  converted  into  a  snow-white,  somewhat  brittle  and  stiff 
substance.  The  pleura  and  the  parts  immediately  underlying  it 
appear  to  be  specially  affected.  I  presume  that  this  white  sub- 
stance is  adipocere  or  some  substance  closely  resembling  it. 

I  have  never  seen  this  change  in  the  liver,  and  only  once  in  the 
two  kidneys  of  one  mummy.  One  of  these  showed  small  patches 
of  adipocere  (?),  whereas  the  other  was  almost  snow-white.  The 
stomach  of  one  mummy,  though  it  had  kept  its  shape  fairly  well, 
was  completely  converted  into  adipocere.  The  intestines  of  an- 
other had  been  almost  wholly  changed  into  rigid  white  strands  by 
the  same  process. 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         63 

I  have  seen  indications  of  a  similar  change  in  Roman  and  Greek 
bodies,  which  had  been  simply  buried  in  sand.  In  these,  the  change 
occurs  in  the  shape  of  small  white  patches  scattered  over  the  intes- 
tines, lungs,  heart,  and  kidneys,  which  have  a  curious  resemblance 
to  miliary  tuberculosis. 

Microscopically  one  sees  nothing  except  an  amorphous  substance 
staining  faintly  with  haematoxylin.  Here  and  there,  however,  one 
finds  places  where  the  structure  of  the  organ  is  preserved. 

METHODS   OF   HISTOLOGICAL  EXAMINATION 

The  naked-eye  appearance  of  the  tissues  will  be  described  as  we 
treat  of  each;  for  the  present  it  will  be  sufficient  to  say  that  most 
mummified  organs  are  hard  to  the  touch,  brownish  in  colour,  and 
often  very  brittle. 

Even  in  the  damp  heat  of  an  Alexandria  summer,  when  the 
temperature  of  my  laboratory  seldom  feU  below  300  C,  most  of  the 
mummified  pieces  underwent  but  little  change.  Some  pieces  of 
intestines  alone  became  soft  and  pliable  and  gave  off  a  distinct 
musty  odour.  An  exception  must  also  be  made  for  the  skin, 
muscles,  and  internal  organs  of  some  mummies  of  the  XVIIIth- 
XXth  Dynasties,  which,  though  stiff,  had  a  peculiar  soft,  soapy  feel. 

A  satisfactory  microscopical  examination  of  organs  in  such  a 
condition  is  not  possible,  not  only  on  account  of  the  brittleness  of 
the  tissues,  but  also  because  the  microscopic  structure  is  obscured 
by  an  opaque,  dark-brown  colouring  matter  with  which  the  tissues 
are  saturated.  Further,  the  larger  amount  of  the  closely  adherent 
"packing,"  e.g.,  mud,  charcoal,  sand,  and  sawdust,  increases  the 
difficulty. 

The  objects  to  be  attained  were:  (1)  to  soften  the  tissues  in 
order  to  render  them  less  brittle,  (2)  to  remove  the  colouring  matter, 
and  (3)  to  bring  back  consistency  sufficient  for  histological  examina- 
tion. 

Microscopical  sections  had  to  be  prepared,  as  except  in  the  case 
of  muscular  fibres  all  other  methods,  such  as  teasing,  etc.,  proved 
useless  for  the  reasons  already  stated. 

I  need  not  enumerate  all  the  reagents  I  employed  together  and 
seriatim.     The  main  difficulty  was  that  reagents  such  as  alkalies, 


64  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

neutral,  alkaline  and  acid  salts,  mineral  and  organic  acids,  glycerine, 
formol,  acetone,  alcohol,  chloroform,  ether,  etc.,  whether  employed 
together  or  alone  or  in  solutions  of  different  concentrations,  either 
softened  the  tissues  too  much  or  not  enough,  and  the  invariable 
result  was  failure.  After  many  attempts  the  following  stock 
solution  proved  most  useful : 

c.c. 

Alcohol 30 

Water 50 

S  per  cent  carbonate  of  soda  solution 20 

In  some  cases  instead  of  water  and  alcohol  a  1  per  cent  solution 
of  formol  was  used. 

Although  this  solution  generally  gives  good  results,  yet  the 
details  of  the  process  must  often  be  altered.  The  time  during 
which  the  tissues  remain  in  this  solution,  and  the  percentage  of 
alcohol  and  carbonate  of  soda  require  modifying  according  to  the 
size  and  consistency  of  the  tissue  to  be  studied.  The  harder  and 
larger  the  tissue,  the  more  carbonate  of  soda  required,  and  the  longer 
the  time  during  which  the  tissue  must  remain  in  the  liquid.  The 
process,  therefore,  is  delicate,  empirical,  and  requires  constant 
watching.  On  the  whole,  it  is  better  to  soak  small  pieces  (3-5  mm.) 
in  dilute  solutions  of  carbonate  of  soda,  rather  than  larger  ones  in 
stronger  solutions. 

Within  two  minutes  of  placing  the  tissue  in  the  softening  solu- 
tion, a  brownish-yellow  colouring  material  begins  to  dissolve  out. 
This  does  not  diffuse  readily  throughout  the  fluid,  but  falls  to  the 
bottom  of  the  beaker;  so  that  for  hours  and  days  even,  the  lower 
layer  of  fluid  resembles  a  strong  solution  of  iodine,  the  supernatant 
liquid  remaining  almost  colourless.  This  brown  colouring  matter 
is  thus  extracted  not  only  from  organs  which  had  been  removed 
from  the  body  during  the  process  of  embalming  and  then  replaced, 
but  also  from  muscles,  blood  vessels,  etc.,  which  had  been  left  in 
situ;  and  even,  though  in  lesser  quantity,  from  the  heart.  The 
muscles  appear  to  contain  a  great  deal  of  it.  During  this  process, 
a  certain  quantity  of  mud,  sand,  sawdust,  etc.,  drops  off  the  tissue 
and  can  then  be  mechanically  removed. 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES  65 

The  tissues,  especially  the  internal  organs,  after  remaining  in 
the  fluid  for  a  few  hours,  sometimes  become  so  soft  that  the  slightest 
movement  of  the  vessel  may  entirely  break  up  the  material.  Even 
the  removal  of  the  fluid  by  careful  decantation  or  by  means  of  a 
pipette  is  not  infrequently  disastrous,  as  the  flow  of  liquid  may 
suffice  to  disintegrate  the  fragment,  or  the  tissue  may  run  up  the 
pipette  as  a  sticky,  oily,  brown  fluid  containing  a  few  shreds. 

The  difficulty  is  obviated  by  placing  the  piece  which  is  to  be 
softened  on  a  small  wire-platform,  and  adding  softening  fluid  until 
the  layer  of  reagent  above  and  below  the  tissue  are  about  equal. 
When  the  tissue  is  softened  sufficiently,  the  lower  third  of  the  fluid, 
containing  most  of  the  colouring  matter,  is  pipetted  off  and  replaced 
by  absolute  alcohol.  The  same  process  is  repeated  on  three  con- 
secutive days,  and  on  the  fifth  day  the  tissue  has  become  so  firm 
that  all  the  fluid  can  be  poured  off  and  replaced  by  absolute  alcohol, 
or  acetone. 

Under  the  influence  of  the  solution  the  mummified  pieces 
become  of  grey  colour  and  somewhat  transparent,  as  if  they  had 
been  plunged  for  some  hours  in  a  clearing  fluid,  e.g.,  turpentine  or 
oil  of  cloves.  A  certain  amount  of  differentiation  is  then  notice- 
able: the  mucous  membrane  of  the  intestine  stands  out  from  the 
muscular  layer,  the  fiver  tissue  from  the  Glisson's  capsule,  the 
pleura  from  the  lung;  but  as  alcohol  is  added,  all  differentiation 
disappears,  and  every  tissue,  though  remaining  pliable,  becomes 
opaque  again  and  of  a  dirty-grey  colour. 

The  material  is  now  plunged  in  chloroform.  Sometimes  this 
liquid  extracts  a  further  quantity  of  colouring  matter;  at  other 
times  a  precipitate  is  formed.  Embedding  in  paraffine,  carried  out 
in  the  usual  manner,  then  follows,  and  the  pieces  are  ready  for 
cutting.  Very  thin  sections  (one  division  of  Minot's  microtome) 
are  easily  obtained,  but  present  no  advantages.  The  famous  dic- 
tum attributed  to  Virchow  "nur  so  dick  wiemoglich"  is  certainly 
true  for  this  work.  For  staining,  acid  and  basic  dyes  are  equally 
useful.  The  best  colorations  are  obtained  with  a  dilute  solution  of 
Bohmer's  haematoxylin  or  a  o.  5  per  cent  solution  of  acid  fuchsine. 
After  staining,  the  sections  are  dehydrated,  cleared,  and  mounted 
in  Canada  balsam  in  the  usual  manner. 


66  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

HISTOLOGICAL   EXAMINATION   OF   THE    SKIN 

I  obtained  from  the  Museum  in  Cairo  particles  of  skin  of  the 
bodies  of  the  Hearst  collection,  which,  I  am  informed,  are  between 
eight  thousand  and  twelve  thousand  years  old.  The  tissue  was 
extremely  fragile  and  disappeared  almost  entirely  in  the  ordi- 
nary softening  solution.  The  skin  could  be  prepared  for  section 
by  using  a  solution  containing  only  0.25-0.50  per  cent  of 
carbonate  of  soda.  In  such  preparations  the  epidermis  had 
completely  disappeared  but  the  dermis  had  retained  its  peculiar 
structure  fairly  well.  The  extraordinary  part,  however,  is  that 
many  of  the  nuclei  of  the  subcutaneous  tissues  still  stained  darkly 
with  haematoxylin  (Plate  XVI,  Fig.  6).  The  amount  of  material 
at  my  disposal  was  so  small  that  I  was  not  able  to  get  many 
preparations. 

Before  the  body  was  put  up  into  the  macerating  solution  (soda 
bath)  by  the  embalmers,  each  nail  of  both  hands  and  feet 
was  carefully  secured  by  a  piece  of  string  wound  in  a  circular  manner 
round  the  finger  or  toe,  so  that  when  the  epidermis  peeled  off,  it  did 
not  carry  the  nails  with  it.  The  impressions  left  by  these  pieces  of 
string  are  visible  in  almost  all  cases,  and  it  often  happens  that  the 
string  is  left  in  position  on  one  or  more  fingers  or  toes.  In  most 
cases,  however,  the  string  was  removed  when  the  body  was  taken 
out  of  the  salt  tank.  Professor  Elliot  Smith  gives  various  photo- 
graphs illustrating  this,  but  as  I  shall  show  presently,  in  many  cases 
the  epidermis,  especially  that  of  the  toes  and  hands,  is  practically 
normal. 

Several  pieces  of  skin  from  the  front  of  the  chest  and  fingers  of 
various  men  and  from  one  woman  were  examined.  The  whole 
finger  of  one  mummy  was  macerated  for  a  fortnight  in  90  per  cent 
alcohol,  containing  3  per  cent  of  pure  nitric  acid,  then  transferred 
to  pure  alcohol,  which  was  repeatedly  changed  until  all  the  acid  had 
been  washed  out. 

The  skin  before  being  prepared  is  yellowish  white,  very  hard, 
and  brittle,  so  hard  indeed  as  often  to  break  the  edge  of  the  knife 
(Plate  XIII,  Fig.  3).  When  broken  across,  the  fractured  surface  is 
smooth  and  glistening;  the  muscles  below  dark-brown,  hard  and 
glistening,  with  a  distinctly  resinous  fracture.      The  connective 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES  67 

tissue,  fat,  etc.,  between  the  muscle  and  skin  are  not  recognis- 
able. Under  the  influence  of  the  softening  solution,  the  skin 
of  the  chest  and  mammae  separate  into  two  layers;  the  first  is 
composed  of  the  muscles  and  the  greater  part  of  the  connect- 
ive tissue,  which  sink  to  the  bottom  of  the  vessel,  and  the  second 
of  the  dermis  which  floats  on  the  surface.  The  latter  is  ex- 
quisitely smooth,  soft  and  much  resembles  yellow  wash-leather, 
except  that  it  is  not  so  pliable. 

The  epidermis  on  the  fingers  is  well  preserved,  and  long  thin 
strips  of  yellow  colour  float  off  when  the  finger  is  allowed  to  soak  in 
the  acid  alcoholic  solution.  These  prove  to  be  layers  of  horny 
scales,  which,  though  somewhat  thinned  out,  are  easily  recognisable 
(Plate  XVI,  Fig.  4). 

The  rete  mucosum  of  the  skin  of  chest  and  mammae  is  almost 
completely  gone  (Plate  XVI,  Fig.  2).  I  at  first  attributed  this  state 
of  things  to  the  effect  of  the  salt  bath,  but  that  it  cannot  be  wholly 
due  to  this  is  proved  by  the  fact  that  the  epidermis  of  bodies  which 
had  certainly  never  been  placed  in  this  bath  had  aJso  fallen  off. 
This  shedding  of  the  epidermis  did  not  take  place  in  the  softening 
solution  used  by  me,  for  some  of  the  extraneous  material  in  which 
the  skin  had  been  packed  (bits  of  bandages  and  sawdust,  etc.)  was 
still  in  contact  with  the  corium  (Plate  XVI,  Fig.  20).  The  few 
epithelium  cells  which  are  left  behind  are  usually  found  in  the 
depressions  between  the  papillae,  forming  the  somewhat  wavy  free 
border  of  the  preparation. 

The  outermost  layer  of  the  corium  of  the  chest  and  mammae  is 
represented  by  wavy  homogeneous  tissue  with  no  particular  struc- 
ture. Its  texture,  however,  is  closer  than  in  the  parts  below  and  it 
stains  intensely.  The  deeper  parts  of  the  corium  and  the  connective 
tissue  below  form  a  loose  network;  so  loose  indeed  as  to  show  that 
a  good  deal  of  the  original  connective  tissue  has  disappeared 
(Plate  XVI,  Fig.  2). 

Some  preparations  are  riddled  with  almost  circular  holes,  which, 
as  their  walls  have  no  particular  structure,  must  have  been  formed 
post  mortem.  Some  of  these  cavities  extend  to  the  outer  edge  of 
tli'-  preparation  ;m<l  open  out  on  the  surface.  I  suggest  that  they 
are  flue  to  gas  bubbles  formed  during  the  process  of  putrefaction. 


68  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

In  preparations  of  the  chest  and  mammae,  sweat  glands  and 
other  glands  cannot  be  identified  with  certainty.  Well-defined  blood 
vessels  are  not  rare,  and  the  fat,  loose  connective  tissue  and  volun- 
tary muscles  of  some  of  the  deeper  parts  of  the  skin  are  beautifully 
preserved.  Nuclei  can  be  demonstrated  in  the  connective  tissue; 
and  so  dense  is  this  underlying  tissue  still  that,  as  has  been  described 
already,  it  often  separates  from  the  dermis  and  sinks  in  the  softening 
fluid. 

The  skin  of  the  fingers  is  in  an  astonishingly  good  state  of  pres- 
ervation. The  layer  of  horny  tissue  which  floats  off  in  acid  alcohol 
when  washed,  stained,  and  mounted,  shows  individual  horny  cells 
plainly  (Plate  XVI,  Fig.  4).  The  other  microscopical  appearances 
of  the  skin  in  this  region  are  easily  seen,  and  although  the  epider- 
mic cells  are  occasionally  absent,  yet  the  epidermic  layer  is  often 
complete  over  large  surfaces. 

The  epidermis  does  not  stain  very  readily  and  the  cells  remain 
of  a  yellowish  colour,  whereas  their  nuclei  turn  a  pale  red  in  acid 
fuchsin  and  greyish  mauve  in  haematoxylin  (Plate  XVI,  Fig.  1). 

Under  a  high  power  the  contours  of  some  of  the  cells  are  some- 
times distinct;  the  lowest  cells  are  occasionally  pigmented,  and  the 
pigment  varies  from  light  yellow  to  brown.  Distinct  granules  are 
generally  absent,  the  pigment  being  usually  diffused  through  the  cell. 

The  papillae  and  the  dense  connective  tissue  of  the  corium  stain 
brightly  and  nuclei  are  not  infrequently  seen  (Plate  XVI,  Fig.  1). 

The  wavy  elastic  fibres  greedily  absorb  acid  fuchsin. 

The  deeper  connective  tissue  and  the  fat  are  in  a  remarkably 
good  state  of  preservation,  although,  except  occasionally,  no  nuclei 
are  evident. 

The  sweat  glands  are  not  always  easily  found,  owing  to  their 
being  greatly  compressed  by  the  connective  tissue.  Sometimes, 
however,  they  are  unmistakable  and  form  a  yellowish-green  streak 
lined  by  the  nuclei  of  the  epithelium  cells  (Plate  XV,  Fig.  3). 
Their  ramified  endings,  though  somewhat  flattened,  are  distinct 
and  the  epithelium  cells  show  the  same  staining  reactions  as  those 
of  the  epidermis  (Plate  XVI,  Fig.  3). 

The  arrangement  of  the  fat  and  connective  tissue  is  well  seen 
in  Plate  XVI,  Figs.  1,  2,  5,  7. 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         69 

In  contrast  with  the  dry  and  resinous  state  of  the  skin  of  the 
mummies  of  the  XXIst  Dynasty  which  had  been  carefully  packed 
with  rags,  mud,  and  sand,  the  skin  of  the  mummies  of  the  XVIIIth- 
XXth  Dynasties,  which  were  given  me  by  Professor  Petrie,  was 
almost  soft  and  flexible.  It  was  possible  to  strip  off  the  skin  from 
the  subjacent  muscles,  and  a  subcutaneous  layer  of  yellowish  fat 
was  still  present.  The  limbs  of  these  mummies  had  not  been  packed, 
nevertheless  the  muscles,  cartilages,  ligaments,  and  nerves  were  in 
an  extraordinarily  good  state  of  preservation.  The  microscopical 
appearances  were  identical  with  those  of  the  skin  of  the  chest  and 
mammae  which  have  just  been  described;  the  horny  layer  had 
completely  disappeared. 

The  skin  of  a  Greek  mummy1  dating  from  about  300  to  400  B.C. 
was  fairly  soft.  After  lying  in  Alexandria  for  some  months  it 
became  soapy  to  the  touch  and  was  easily  dissected  from  the  under- 
lying tissues.  Histologically,  its  structure  was  similar  to  that  of 
the  skin  of  the  chest  and  mammae  of  the  XXIst  Dynasty. 

I  had  an  opportunity  also  of  examining  the  skin  of  a  Roman 
child  which  had  been  buried  in  the  sand.  The  face  was  gilded,  but 
no  incision  was  found,  and  all  the  organs,  including  the  brain,  were 
in  situ.  The  skin  was  rather  soapy  to  the  touch,  soft  and  pliable, 
and  large  pieces  of  it  were  stripped  off.  Its  microscopical  structure 
was  identical  with  that  of  mummies  of  the  XXIst  Dynasty. 

I  also  examined  the  skin  of  a  child  probably  belonging  to  the 
Greek  period.  This  had  been  buried  in  the  sand,  but  there  was 
absolutely  no  sign  that  it  had  ever  been  touched  by  the  embalmer. 
The  skin  was  fairly  soft  and  dry.  The  whole  of  the  epidermis  of 
the  soles  of  the  feet  and  toes  was  almost  completely  detached  so  that 
it  could  easily  be  removed  with  a  forceps.  Microscopically  the 
epidermic  cells  were  plainly  seen,  but  the  sections  of  the  skin  were 
not  very  satisfactory. 

The  skins  of  several  heads  which  had  been  buried  in  the  sand  at 
Mellawi  were  well  preserved,  and  so  dry  that  in  spite  of  a  prolonged 
stay  in  the  softening  solution  they  never  swelled  up  to  a  great  extent. 

■  This  mummy  was  given  me  by  the  Museum  authorities.  I  was  told  that  it 
belongs  G         period,  but  it  was  prepared  exactly  the  same  way  as  the  mum- 

-    the  XXIst  Dynasty.     Its  limljs  had  not  been  packed  in  any  way.    The  body 
was  undoubtedly  that  of  an  Egyptian. 


70  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  hairs  and  follicles  were  easily  seen.  The  epidermic  cells  of  the 
scalp  had  not  been  shed  and  were  represented  by  a  thin,  darkly 
staining  fringe.  The  date  at  which  these  people  lived  is  uncer- 
tain, though  the  bodies  were  certainly  more  than  two  thousand 
years  old. 

From  the  appearance  of  the  skin  I  conclude  that  most  probably 
putrefaction  had  not  gone  very  far  before  the  bodies  were  either 
buried  in  the  sand  or  steeped  in  the  pickling  solution.  With  the 
onset  of  putrefaction  the  epidermis  is  raised  and  ultimately  falls  off. 
This  process  starts  in  the  regions  nearest  the  abdominal  cavity,  viz., 
the  abdominal  walls,  the  skin  of  the  chest  and  back,  and  shows 
itself  last  near  the  extremities,  i.e.,  toes  and  fingers. 

Considering  that  the  epidermic  cells  had  disappeared  on  the  chest, 
it  is  possible  that  putrefaction  had  just  started  before  burial,  or  before 
the  bodies  were  placed  in  the  natron  solution.  It  was  certainly 
not  very  far  advanced  as  no  micro-organisms  were  seen. 

The  observation  of  Professor  Elliot  Smith  to  the  effect  that  in 
some  mummies  each  nail  was  securely  tied  to  the  finger,  seems  to 
show  that  the  epithelium  was  often  shed  in  the  "natron"  solution 
and  that  this  had  some  caustic  property.  On  the  other  hand,  the 
fact  that  the  skin  including  the  epidermis  of  certain  bodies  was 
almost  normal  shows  that  the  "natron"  cannot  always  have  had  a 
very  powerful  macerating  effect. 


These  muscles  are  as  dry  as  tinder  and  flake  off  easily.  They 
much  resemble  dry  camomile  leaves  and,  like  the  latter,  can  easily 
be  crushed  to  powder  between  the  fingers.  They  dissolve  entirely 
in  the  ordinary  softening  solution,  but  their  structure  is  made 
evident  by  placing  them  in  30  per  cent  alcohol  containing  only  a 
trace  of  carbonate  of  soda.  A  small  fragment  is  then  teased  out 
under  the  microscope  from  time  to  time,  when  after  an  hour  or  two 
the  transverse  striation  of  the  muscular  fibres  and  the  sarcolemna 
are  demonstrable  as  a  rule.  The  striation  is  regular,  though  owing 
to  the  great  shrinkage  of  the  muscle  the  transverse  bands  are  of 
course  much  smaller  than  in  the  muscles  of  modern  times  (Plate 
XVII,  Fig.  2). 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         71 

The  voluntary  muscles  examined  were  the  great  pectoral,  dia- 
phragm, cremaster,  and  finger  muscles,  and  all  proved  equally  good 
objects  for  histological  examination. 

Their  appearance  is  very  deceptive,  as  sometimes  they  resemble 
a  lump  of  resin,  so  that  the  diagnosis  between  the  muscles  and  resin 
by  the  naked  eye  is  not  infrequently  almost  impossible.  As  an 
instance,  I  may  relate  that  the  first  muscular  fibres  which  I  ever 
saw  were  found  while  examining  under  the  microscope  a  small  par- 
ticle of  what  I  had  thought  to  be  resin.  Such  a  muscle  is  of  stony 
hardness  and  brittle.  When  broken  across  it  shows  a  smooth, 
dark-brown,  shiny,  and  glistening  surface.  In  other  cases  the 
muscle  is  pale  yellow,  fibrous  in  appearance,  and  thin  strands  can 
then  be  easily  teased  out.  This  was  especially  so  in  mummies  of  the 
XVIIIth-XXth  Dynasties,  in  which  the  limbs  had  not  been  packed. 

For  purposes  of  demonstration,  small  fragments  were  macerated 
in  a  very  weak  solution  of  caustic  potash  (0.5-0.01  per  cent)  and 
then  teased.  The  teased  fibres  were  stained  with  eosin  or  acid 
fuchsin,  washed  in  water,  alcohol,  xylol,  and  mounted  in  Canada 
balsam  (Plate  XVII,  Fig.  2).  Unstained  preparations,  however, 
show  histological  details  quite  as  well  if  not  better  than  stained 
slides. 

The  fibres  appear  to  be  somewhat  stiffer  and  thinner  than 
normal.  The  transverse  striation  is  conspicuous  throughout  the 
whole  length  of  the  fibre.  The  perfectly  stained  transverse  bands 
are  certainly  not  as  wide  as  those  of  modern  muscles.  No  doubt 
the  shrinkage  clue  to  a  desiccation  lasting  nigh  on  three  thousand 
years  has  not  been  compensated  by  a  few  hours  stay  in  alkaline 
fluid.     Nuclei  are  never  seen. 

The  sarcolemma  is  often  noticeable  and  forms  a  thin  transparent 
membrane,  specially  well  seen  where,  during  manipulation,  the  fibre 
has  been  twisted  or  torn  (Plate  XVII,  Fig.  3).  The  striation  is  also 
obvious  in  sections,  provided  these  are  nearly  parallel  to  the  long 
axis  of  the  muscle,  which  is  seldom  the  case.  The  muscle  then  often 
looks  as  if  it  were  breaking  into  discs,  and  this  is  especially  marked 
in  sections  on  the  cremaster  muscle. 

In  transverse  sections,  the  perimysium  stains  readily  and  deeply, 
and  its  prolongations  between  the  fasciculi  are  easily  demonstrated. 


72  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  endomysium  is  visible  if  the  section  is  deeply  stained  and  shows 
as  thin,  dark  strands,  so  fine  and  sharp  that  they  look  as  if  they  had 
been  painted  in  with  a  pen  dipped  in  the  darkest  blue  ink.  On  the 
whole,  although  sections  of  muscles  both  longitudinal  and  transverse 
give  excellent  pictures  of  peri-  and  endomysium,  yet  the  teasing 
method  is  to  be  preferred  when  the  object  in  view  is  to  demonstrate 
the  traverse  striation. 

I  may  mention  that  I  found  striated  muscular  fibres  in  the  con- 
tents of  the  intestinal  canal  of  a  mummy  of  the  XXIst  Dynasty. 
It  is  not  a  little  astonishing  that  these  muscular  fibres,  which  had 
probably  undergone  a  certain  amount  of  digestion,  should  have  kept 
their  structure  for  over  three  thousand  years. 

The  muscles  of  the  limbs  of  Greek  and  Roman  mummies  are 
hard,  fibrous,  and  by  no  means  brittle.  They  can  be  teased  out 
almost  as  easily  as  fresh  muscles.  A  large  amount  of  colouring 
matter  dissolves  out  in  the  softening  solution  and  the  tissue  be- 
comes soft  and  pliable.  The  striation  is  then  easily  demonstrated. 
On  the  whole,  these  muscles  are  as  perfect  as  those  of  the  XXIst 
Dynasty,  although  no  preservatives  whatever  appear  to  have  been 
used  for  the  muscles  of  the  limbs  of  these  Greek  and  Roman  mum- 
mies. Similarly  I  found  that  the  muscles  of  Egyptian  mummies 
of  the  XVIIIth  and  XXth  Dynasties,  which  had  been  simply  dried, 
gave  beautiful  histological  pictures. 


Excellent  results  were  obtained  by  making  transverse  sections 
through  the  finger.  The  whole  finger  was  macerated  for  a  fortnight 
in  90  per  cent  of  alcohol  containing  3  per  cent  of  pure  nitric  acid, 
then  transferred  to  pure  alcohol,  which  was  repeatedly  changed 
until  all  the  acid  was  washed  out. 

The  digital  nerves  are  in  a  very  fine  state  of  preservation  and 
easily  identified,  not  only  by  their  position  with  regard  to  the  digital 
arteries  and  other  structures,  but  also  by  their  characteristic  his- 
tological appearances.  The  funiculi  have  a  wavy  aspect,  which 
is  less  marked  than  in  fresh  tissue,  and  as  the  connective  tissue 
always  swells  up  rather  unequally  under  the  influence  of  the  softening 
solution,  blank  spaces  are  often  left  between  the  connecting  fibres. 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES  73 

Similarly,  owing  to  shrinkage,  the  funiculi  do  not  always  fill  up  the 
spaces  between  the  septa  formed  by  the  epineurium  (see  Plate  XVII, 
Fig.  1).  In  some  cases,  however,  the  sections  are  perfect,  and  no 
blank  spaces  are  left. 

The  endoneurium,  on  the  other  hand,  is  excellently  preserved, 
and  in  consecutive  serial  sections  not  a  fibre  is  missing,  and  the  blood 
vessels  even  are  unaltered.  The  outer  or  primitive  sheath  of  the 
nerve  fibre  is  so  closely  applied  to  the  endoneurium  that  it  cannot 
be  separately  demonstrated. 

Under  a  low  power,  the  interior  of  the  nerve  fibre  has  a  peculiar 
glistening  appearance,  which  it  was  almost  beyond  the  artist's 
power  to  reproduce.  Under  a  high  power,  however,  the  tube  is 
seen  to  contain  a  greenish-yellow  substance,  which  stains  best  with 
haematoxylin  (Plate  XV,  Figs.  1  and  2),  and  acid  fuchsin,  and 
evidently  represents  the  medullary  sheath.  In  many  of  the  nerve 
tubes,  a  dot  staining  deeply  with  both  dyes  probably  represents  the 
axis  cylinder  (Plate  XV,  Fig.  2,  and  Plate  XVII,  Fig.  1).  The 
number  of  these  dots  varies  greatly,  some  sections  showing  them 
in  almost  every  fibre,  whereas  in  other  preparations  they  are 
very  rare. 

Nerve  trunks  were  obtained  by  dissection  from  mummies  of  the 
XVIIIth-XXth  Dynasties.  The  whole  limb  was  immersed  in  solu- 
tion containing  formol  o .  5  per  cent,  carbonate  of  soda  1  per  cent, 
and  water  to  100.  The  skin  after  a  day  or  two  became  soft  and 
flexible  and  was  then  stripped  off  and  the  limb  replaced  in  the  solu- 
tion. After  a  few  days,  nerves,  muscles,  ligaments,  etc.,  were 
dissected  out. 

The  nerves  especially  are  in  a  very  fine  state  of  preservation, 
and  can  be  followed  almost  as  easily  as  in  a  fresh  specimen.  For 
histological  examination,  small  fragments  of  nerves  are  placed  in 
30  per  cent  alcohol  for  twenty-four  hours  and  afterwards  hardened 
and  cut  in  the  usual  manner.  The  nerves  present  the  same  appear- 
ance as  those  described  above,  except  that  the  axis  cylinders  are 
not  visible  as  a  rule;  the  medullary  sheath  on  the  other  hand  is 
very  conspicuous. 

These  nerves  are  in  no  better  state  of  preservation  than  those 
of  mummies  of  the  XVIIIth-XXth  Dynasties. 


74  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

BLOOD   VESSELS 

The  state  of  the  blood  vessels  varies  exceedingly,  probably  owing 
to  their  having  been  subjected  after  death  to  widely  different 
influences  according  to  their  position  in  the  body. 

Clearly,  the  chemical  processes  (putrefaction,  autolysis)  modi- 
fying the  anatomical  structure  of  blood  vessels  after  death  were  not 
as  active  in  the  peripheral  parts  of  the  body,  as  for  instance  fingers 
and  toes,  as  in  a  large  internal  organ,  e.g.,  liver.  As  several  hours 
undoubtedly  passed  between  death  and  the  removal  of  the  organs 
from  the  body  and  the  immersion  in  the  pickling  solution,  some 
putrefactive  changes  may  have  taken  place  in  all  internal  organs, 
especially  during  hot  weather;  and  this  must  have  been  the  case 
also  to  some  extent  with  the  skin,  especially  the  skin  and  sub- 
cutaneous tissue  of  the  trunk. 

On  the  other  hand,  the  putrefactive  bacteria  and  their  products 
probably  never  reached  the  tissues  of  the  extremities,  which  there- 
fore were  almost  sterile  when  the  body  was  placed  in  the  pickling 
solution. 

After  the  removal  of  the  organs,  the  large  vessels  of  the  neck 
near  the  heart  were  filled  with  mud  and  sand  and  are  considerably 
damaged  in  consequence,  'it  appears  to  me  doubtful  whether  in 
some  mummies  the  pickling  solution  ever  reached  the  heart,  as  the 
consistency  of  this  organ  often  differs  entirely  from  that  of  other 
muscles.  The  muscles  of  the  heart  may  crumble  to  dust  when 
pressed  between  the  fingers,  and  when  carefully  broken  they  show 
a  granular,  dull-grey,  fractured  surface,  even  when  the  other  muscles* 
of  the  body  are  of  stony  hardness  and  show  a  glistening,  brown, 
resinous  fracture.  The  consistency  of  the  vessels  of  the  neck  may 
resemble  that  of  the  heart,  whereas  the  lower  part  of  the  thoracic 
aorta  is  entirely  different,  its  fractured  surface  resembling  that  of 
muscle. 

Elliot  Smith  has  pointed  out  correctly  that  the  aorta  was 
generally  removed  in  mummies  of  the  XXIst  Dynasty.  I  have 
found  this  vessel,  however,  in  mummies  of  the  XVIIIth-XXth 
Dynasties  and  also  in  a  Greek  ( ?)  mummy.  The  aorta  was  abso- 
lutely collapsed  and  would  certainly  not  have  been  found,  sur- 
rounded as  it  was  with  packing  (sawdust  and  mud),  had  the  whole 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES  75 

mummy  not  been  placed  in  the  softening  solution.  All  the  coats 
of  the  vessel  could  be  easily  demonstrated  under  the  microscope 
(Plate  XVIII,  Fig.  3). 

The  intima  of  the  large  veins  and  arteries  near  the  heart  is  not 
to  be  seen  as  a  rule  (Plate  XVIII,  Fig.  2),  having  probably  been 
torn  off  when  these  vessels  were  forcibly  filled  with  sand  or  mud. 
The  adventitia  of  these  vessels  is  not  well  seen  and  the  middle  coat 
is  often  represented  by  very  thin  annular  fibres  only,  which  probably 
correspond  to  the  muscular  coat  (Plate  XVIII,  Fig.  2). 

In  the  pickling  solution,  organs  such  as  intestines  were  quickly 
saturated  with  natron  and  the  putrefactive  changes  were  arrested. 
On  the  other  hand,  the  internal  parts  of  larger  and  thicker  organs, 
as  for  instance  liver  and  kidneys,  were  not  impregnated  with  salt 
for  a  considerable  time,  if  indeed  the  salt  ever  penetrated  them 
deeply.  It  certainly  seems  to  me  doubtful  also  whether  the  salt 
ever  reached  the  deeper  part  of  the  limbs,  notably  of  the  extremities. 

The  question  is  only  to  be  settled  by  experiment;  but  in  any 
case,  it  is  evident  that  the  action  of  the  salt  on  blood  vessels  varied 
according  to  the  anatomical  position  of  the  blood  vessels.  Simi- 
larly, the  autolytic  processes  must  have  produced  more  or  less  effect 
on  the  arteries  and  veins  according  to  the  size  of  the  organs  in  which 
the  vessels  were  embedded.  Lastly,  the  internal  parts  of  the  liver 
and  kidneys  dried  much  more  slowly  than  the  more  superficial 
organs,  and  these  organs  themselves,  owing  to  their  size  and 
structure,  were  desiccated  much  more  slowly  than  other  tissues. 

Considering,  therefore,  that  all  the  processes  tending  towards 
the  production  of  alterations  in  the  blood  vessels  were  more  marked 
in  the  larger  organs,  we  should  expect  (leaving  the  heart  and  the 
arteries  and  veins  of  the  neck  out  of  consideration  as  having  been 
subjected  to  a  special  form  of  treatment)  that  the  state  of  preserva- 
tion of  blood  vessels  would  vary  according  to  the  size  of  the  organ 
containing  them. 

On  the  whole,  the  facts  are  in  accordance  with  theoretical  con- 
siderations. In  the  largest  organ,  the  liver,  the  portal  system  has 
almost  wholly  disappeared;  and  though  the  hepatic  system  shows 
less  profound  alterations,  yet  often  enough  the  larger  veins  are  repre- 
sented by  a  few  shreds  of  tissue  only  (Plate  XIX,  Figs.  2  and  3) . 


76  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  blood  vessels  of  the  parenchyma  of  the  lungs  are  very 
distinct.  This  is  probably  due  to  the  fact  that  the  lungs  do  not 
putrefy  as  quickly  as  the  abdominal  organs  and  that,  owing  to 
their  loose,  spongy  structure,  the  salt  solution  penetrated  them 
rapidly  and  the  organs  dried  quickly  afterwards. 

The  vascular  system  of  the  stomach  and  intestines  is  often  well 
preserved.  The  three  coats  of  the  arteries,  for  instance,  are  evident. 
Here  the  satisfactory  result  is  probably  due  to  the  thorough  and 
rapid  penetration  of  the  pickling  solution,  and  the  ulterior  quick 
desiccation  of  the  thin  tissues. 

The  vessels  of  the  extremities,  i.e.,  fingers,  are  most  interesting; 
the  adventitia  and  media  are  well-nigh  perfect,  the  intima  alone 
showing  signs  of  disintegration  (Plate  XVIII,  Fig.  4).  Similarly, 
the  small  blood  vessels  of  the  testis,  of  nerves  and  muscles  are  in 
excellent  condition. 


In  mummies  of  the  XXIst  Dynasty  the  heart  is  always  shrunk 
to  an  extraordinary  extent  (Plate  XIV,  Figs.  2  and  3).  The  organ 
depicted  here,  for  instance,  measures  5.5  cm.  in  length,  4  cm.  in 
breadth,  and  5 . 5  cm.  in  depth,  and  weighs  26  gm.  It  is  is  obviously 
torn  or  incised  along  both  its  anterior  and  posterior  surfaces.  The 
ventricles  are  very  well  preserved,  but  the  auricles  with  the  origins  of 
the  larger  veins  are  collapsed  and  shrunk,  and  are  invaginated  into 
the  ventricles.  Prolonged  desiccation  and  consequent  shrinking  have 
thrown  all  the  surface  of  the  heart  into  deep  wrinkles,  and  the  whole 
organ  is  as  dry  as  tinder,  requiring  very  careful  handling  if  it  is  to 
be  kept  intact.  Fragments  chip  off  readily  and  crumble  to  dust 
under  very  slight  pressure. 

Several  attempts  were  made  to  restore  such  a  mummified  heart 
to  its  former  shape  by  leaving  it  for  some  time  in  the  softening 
solution.  Apparently,  all  the  connective  tissues  had  disappeared 
during  centuries  of  drying,  for  after  a  few  hours  the  muscular 
bundles  fell  apart.  These  were  of  a  pale-yellow  colour,  and  as 
transparent  as  if  they  had  been  soaked  in  some  clearing  reagent  such 
as  xylol.  A  good  deal  of  sand  which  had  obviously  been  contained 
in  the  heart  and  blood  vessels  dropped  to  the  bottom  of  the  vessel. 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         77 

The  tricuspid,  mitral,  and  aortic  valves  were  intact  and  fairly  tough, 
though  as  thin  as  the  flimsiest  tissue  paper. 

As  Professor  Elliot  Smith  pointed  out,  the  heart  was  generally 
left  in  the  body  cavity  of  mummies  of  the  XXIst  Dynasty.  In  a 
mummy  of  the  XVIII-XXth  Dynasties,  however,  I  found  that  it 
had  been  removed.  Within  the  pericardium  there  was  a  largish 
bundle  containing  both  kidneys,  and  behind  the  liver  I  found  a 
small  packet,  containing  a  bundle  of  muscular  fibres.  This  prob- 
ably represented  the  heart,  the  embahner  having  evidently  made 
a  mistake  and  put  the  kidneys  in  the  wrong  place. 

Under  the  microscope  hardly  any  connective  tissue  remains 
between  the  muscular  fibres,  so  that  in  many  sections  none  can  be 
demonstrated. 

The  muscular  fibres  are  normal  in  so  far  that  the  transverse 
striation  and  the  individual  fibres  are  readily  shown,  whether  run- 
ning parallel  or  crossing  one  another.  These  are  considerably 
shrunk  both  longitudinally  and  laterally.  The  striation  lines  are 
much  closer  to  one  another  than  in  the  normal  human  heart  and  the 
fibres  themselves  are  correspondingly  narrowed. 

In  the  bodies  of  Roman  and  Greek  children  buried  in  the  sand, 
the  heart  is  of  course  in  situ.  The  microscopical  examination  of 
the  muscular  fibres  gives  no  better  results  than  in  the  older  mum- 
mies. The  valves  appear  normal  and  are  readily  demonstrated 
when  the  heart  is  properly  softened.  The  only  difference  is  that 
the  organ  does  not  fall  to  pieces,  as  is  the  case  in  mummies  of  the 
XXIst  Dynasty,  and  that  the  connective  tissue  can  be  demonstrated. 


The  liver,  owing  to  its  bulk,  necessarily  dried  very  slowly  and 
therefore  underwent  profound  changes.  The  organ  represented  in 
Plates  XII  and  XIII  had  evidently  been  compressed  into  the  form 
of  a  tube,  and  either  before  or  after  drying,  part  of  the  organ  had 
been  torn  away.  It  measured  22.5  cm.  in  its  longest  and  7  cm.  in 
its  broadest  diameter,  and  it  was  nowhere  more  than  4  cm.  thick. 
It  weighed  300  gm.  with  its  bandages. 

We  must  remember  in  this  connection  that  the  incision  through 
which  the  liver  was  extracted  measured  not  more  than  5  inches  as 


78  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

a  rule,  and  it  is  very  difficult  to  understand  how  the  embalmers 
removed  this  enormous  organ  through  this  comparatively  small 
opening.  The  liver  was  frequently  damaged,  and  the  embalmers 
did  not  always  take  the  trouble  to  replace  the  whole  of  the  organ 
into  the  body  cavity.  The  liver  depicted  here  is  the  most  perfect 
I  have  ever  seen  and  almost  an  exception.  In  other  cases  the  organ 
was  represented  by  a  few  ounces  of  tissue  only,  the  rest  having 
completely  disappeared. 

The  liver  of  the  Greek  mummy  was  fairly  perfect,  but  neverthe- 
less a  large  part,  viz.,  the  quadrate  lobe,  the  gall  bladder,  all  the 
hepatic  vessels,  and  caudate  and  Spigelian  lobes  had  been  torn 
away. 

Fragments  of  five  different  livers  were  examined.  These  were 
as  hard  as  stone  and  when  broken  across  expose  a  mahogany-brown, 
smooth,  glistening  surface.  In  the  softening  solution  they  showed, 
as  a  rule,  a  marked  tendency  to  fall  into  minute  fragments,  and  the 
slightest  movement  of  the  vessel  caused  the  tissue  to  break  up  into 
a  nocculent  precipitate.  Much  of  the  hepatic  substance  had  disap- 
peared, and  even  when  treated  with  the  greatest  care,  the  fragments 
formed  small  laminae  which  readily  separated  from  one  another. 
After  many  failures  large  pieces  of  tissue  were  prepared  for  micro- 
scopical examination  by  carefully  adding  absolute  alcohol  drop  by 
drop  to  the  softened  fragments.  The  bile  ducts  had  completely  or 
almost  completely  disappeared.  In  two  livers  not  a  trace  of  such 
a  channel  remained.  In  a  third  a  few  bile  ducts  were  observed, 
these  probably  owing  their  escape  from  destruction  to  the  dense 
connective  tissue  (cirrhosis)  surrounding  them.  The  typical 
arrangement  of  the  lobule,  with  its  cells  radiating  from  the  hepatic 
vein,  was  still  evident  (Plate  XIX,  Figs.  2  and  3),  but  in  almost 
every  section  cells  were  missing  here  and  there,  or  had  been  con- 
verted into  a  thin  reticulum  without  any  definite  structure  (Plate 
XFX,  Fig.  1).  This  is  evidently  a  post-mortem  change  due  possibly 
to  putrefaction,  or  more  probably  to  autolysis. 

The  state  of  preservation  of  the  hepatic  cells  varies  a  good  deal, 
sometimes  even  in  sections  of  the  same  organ.  In  some,  the  cells 
are  converted  into  slender,  almost  homogeneous  strands,  and  so  thin 
as  to  simulate  fibrous  tissue.     In  other  parts  of  the  same  organ 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         79 

the  cells  are  much  larger,  their  lateral  borders  run  into  one  another, 
leaving  but  little  space  between  them.  As  a  rule,  owing  to  the  long 
desiccation  that  they  have  undergone,  they  form  a  network  with 
almost  homogeneous  branches. 

Examination  of  the  plate  (Plate  XIX,  Fig.  3)  shows  that  in 
many  places  several  layers  of  cells  have  been  depicted,  the  super- 
ficial appearing  more  darkly  stained  than  the  deeper  ones. 

The  drying  process  has  evidently  reduced  the  size  of  the  indi- 
vidual cells  so  much  that,  however  thin  the  section  (and  this  one  was 
only  one  micromillimeter  thick),  several  layers  of  cells  are  exhibited. 
Nevertheless,  in  each  preparation,  however  imperfect  the  state  of 
the  organ,  there  is  seldom  any  difficulty  in  recognising  the  typical 
arrangement  of  the  liver  cells. 

Occasionally  the  hepatic  cells  are  in  a  much  better  state  of 
preservation.  In  one  liver  of  the  XXIst  Dynasty,  not  only  can 
individual  hepatic  cells  be  recognised,  but  the  nucleus  of  each  is 
perfectly  plain  (Plate  XIX,  Fig.  3).  The  blood  vessels  of  this 
organ  are  in  a  very  fair  state  of  preservation. 

As  a  rule,  the  state  of  the  vascular  system  is  very  unsatisfactory, 
and  the  blood  vessels  are  often  represented  by  empty  spaces  only 
(Plate  XIX,  Figs.  2  and  3) ;  here  and  there,  torn  and  very  imperfect 
fragments  of  the  walls  of  the  artery  are  found.  The  portal  system 
throughout  appears  to  have  suffered  most,  not  a  trace  of  it  remain- 
ing in  many  sections.  The  hepatic  veins  are  sometimes  in  a  better 
state,  though  in  the  majority  of  lobules  the  walls  of  the  veins  have 
either  disappeared  altogether,  or  are  represented  by  a  few  shreds 
only.  In  no  other  organ  is  the  vascular  system  in  such  an  advanced 
state  of  disintegration. 

The  livers  of  these  children  were  in  an  almost  perfect  state  of 
preservation,  and  histologically,  bile  ducts,  blood  vessels,  cells,  and 
connective  tissue  were  almost  normal. 

I  have  examined  the  gall  bladder  of  a  child  of  the  Greek  period, 
the  histological  structure  of  which  was  almost  perfect. 


'I  he  Lungs  of  the  ancient  Egyptians  were  apparently  dried  in  dif- 
ferentways.     Sometimeseach  lung  when  still  pliable  was  folded,  and 


80  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

the  jackal-headed  figure  Tuamautef  placed  in  the  tube  thus  formed. 
The  pleura,  though  wrinkled  by  desiccation,  is  sometimes  easily 
demonstrated.  Such  lungs  were  certainly  not  bound  to  the  costal 
pleura  by  any  strong  adhesions,  for  had  this  been  the  case,  the 
organs  would  have  been  torn  during  the  process  of  removal.  On 
the  contrary,  they  are  perfect.  The  small  deficiencies  in  the  pleura 
which  I  have  observed  were  probably  produced  post  mortem,  and 
through  the  little  holes  so  formed  the  spongy,  reticular  tissue  of  the 
lungs  was  evident.  One  of  these  lungs,  which  seemed  complete, 
measured  when  dried  19  cm.  in  length,  44  cm.  in  breadth,  and  2  cm. 
in  depth. 

Lungs  were  undoubtedly  often  dried  flat,  and  this  was  certainly 
the  case  with  one  of  the  organs  depicted  in  Plate  XIV.  Here 
the  root  of  the  lung  is  plainly  recognisable,  although  the  main 
bronchi,  pulmonary  artery,  and  vein  cannot  be  separated.  Some 
parts  of  this  organ  are  riddled  with  small  black  holes,  which  I  take 
to  have  been  caused  by  insects. 

What  I  have  said  about  the  difficulty  of  extracting  the  liver  and 
the  probability  of  the  organs  being  torn  when  removed  applies  to 
the  lungs,  though  to  a  less  degree. 

If  the  organ  be  stripped  as  much  as  possible  of  its  bandages  and 
placed  for  several  days  in  the  softening  solution  of  formol  and 
carbonate  of  soda,  the  whole  can  be  made  perfectly  soft.  The  time 
during  which  the  solution  must  be  allowed  to  act  varies  with  each 
lung.  The  process  therefore  must  be  watched  very  carefully,  as, 
if  kept  too  long  in  the  fluid,  the  entire  organ  is  spoilt.  After  a 
period  varying  from  two  days  to  a  week  or  longer,  the  solution  is 
decanted  off  and  replaced  by  a  1  per  cent  formol  solution.  This  is 
changed  on  several  days  and  when  all  the  colouring  matter  has 
dissolved  out,  the  lung  can  remain  for  an  indefinite  length  of  time 
in  a  5  per  cent  formol  solution.  In  some  cases  I  used  30  per  cent 
and  then  60  per  cent  alcohol,  but  the  results  obtained  were  not 
encouraging.  Very  often  it  is  clear  that  the  embalmer  only 
wrapped  a  small  portion  and  sometimes  not  more  than  a  third  of  the 
organ,  and  that  the  rest  of  the  bundle  consists  of  mud  and  vegetable 
matter.  Evidently,  therefore,  the  organ  had  been  badly  torn 
during  removal. 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         81 

I  have  already  alluded  to  the  curious  tendency  possessed  of 
these  organs  to  produce  adipocere  ( ?)  and  I  need  not  describe  its 
formation  again. 

The  parenchyma  of  the  lung  is  as  a  rule  in  a  very  good  state  of 
preservation.  The  alveolar  structure  of  the  organ  is  easily  seen, 
though  of  course  the  fine  details  have  disappeared  (Plate  XX,  Figs, 
i  and  2).  The  walls  of  the  bronchi,  with  the  exception  of  the 
mucous  membrane,  are  much  shrunk  but  well  preserved,  and  the 
cartilages  of  the  larger  bronchi  are  almost  perfect  in  places.  A  few 
cartilage  cells  may  be  absent  or  may  have  shrunk  to  a  mere  point, 
but  as  a  rule  they  are  well  seen.  Two  cells  lying  in  the  same  space 
are  often  distinguishable.  In  a  few  sections  the  nuclei  are  still 
visible  (Plate  XVIII,  Figs.  5a  and  b) . 

The  microscopical  structure  of  the  pleura  and  diaphragm  is 
beautifully  seen  in  transverse  sections.  These  tissues  and  the  mus- 
cular fibres  of  the  diaphragm  especially  are  so  typical  that  it  is 
almost  impossible  to  believe  that  the  material  dates  from  three 
thousand  years.  This  excellent  condition  I  attribute  to  the  thick 
layer  of  mud  which  lined  the  entire  pleural  cavity  of  this  particular 
mummy. 

The  lungs  of  the  Roman  child  were  represented  by  a  granular, 
soapy-feeling  mass  lying  at  the  back  of  each  pleura.  No  particular 
structure  could  be  demonstrated.  The  lungs  of  the  Greek  child 
will  be  described  in  another  paper,  dealing  with  pathological 
changes  in  mummies. 

KIDNEYS 

Sometimes  both  kidneys  were  left  in  situ  and  they  may  easily 
escape  notice  unless  the  whole  mummy  be  softened.  I  have  found 
them  in  a  mummy  of  the  XVIIIth-XXth  Dynasties,  and  once 
I  have  seen  the  stomach  wrapped  up  in  the  same  parcel  as  the  two 
kidneys. 

The  shape  is  well  preserved,  and  the  hilus,  for  instance,  and 
sometimes  even  the  ureters  can  be  recognised.  Occasionally,  again, 
the  suprarenal  capsule  is  still  attached  to  the  kidney. 

Good  sections  of  the  kidney  are  easily  obtained,  as  the  softened 
organ  does  not  fall  to  pieces  as  rapidly  as  other  viscera.  The 
capsule  of  the  kidney  is  practically  perfect. 


82  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  general  histological  structure  of  the  organ  is  readily  seen 
and  the  characteristics  of  every  region  are  distinct  (Plate  XXI, 
Figs,  i  and  3).  The  various  parts  of  the  organ,  however,  expand 
somewhat  unequally;  the  cortex  swelling  up  less  than  the  medulla, 
so  that  the  glomeruli  and  the  tubuli  contorti  are  generally  more 
distinct  than  the  straight  and  connecting  tubules.  The  glomeruli 
are  occasionally  somewhat  angular  in  shape  and  stand  out  promi- 
nently from  the  surrounding  tissue  (Plate  XXI,  Fig.  1).  Their 
characteristic  structure  has  disappeared,  for  long  mummification 
has  converted  them  into  a  finely  reticulated,  spongy-looking  mass, 
in  which  the  epithelium  cells  and  blood  vessels  are  matted  together 
(Plate  XXI,  Fig.  4).  In  some  kidneys  not  a  single  glomerulus  has 
been  destroyed. 

The  tubes  of  the  cortex  are  complete,  though  the  lumen  of  the 
tubes  is  often  closed.  Under  a  high  power  the  individual  cells  are 
not  recognisable  (Plate  XXI,  Fig.  3).  The  whole  tube  forms 
strands  staining  faintly  with  haematoxylin.  The  connective  tissue 
between  the  tubuli  contorti  is  often  very  prominent,  standing  out 
in  sharp  contrast  to  the  faintly  staining  and  sometimes  yellow- 
coloured  epithelium  cells. 

In  other  cases  the  epithelium  layer  is  conspicuous  and  the  con- 
nective tissue  almost  invisible.  If  such  sections  be  floated  through 
alcohol  into  water,  the  currents  set  up  wash  out  the  epithelium  cells 
and  the  connective  tissue  becomes  apparent  (Plate  XXI,  Fig.  5) . 
The  reason  why  the  connective  tissue  is  hidden  until  the  epithelium 
cells  have  been  washed  out,  is  that  both,  having  lost  their  specific 
chemical  properties,  stain  almost  exactly  alike. 

The  large  and  medium-size  blood  vessels  persist,  and  in  some 
cases  they  can  be  recognised  by  their  general  characteristics  only; 
the  details  of  their  microscopical  structure  have  disappeared  (Plate 
XVIII,  Fig.  1).  The  arteries,  but  not  the  veins,  are  contracted, 
and  their  coats  are  converted  into  homogeneous  tissue,  showing  no 
differentiation.  In  other  kidneys,  however,  the  blood  vessels  are 
almost  perfect,  even  as  regards  the  details  of  their  histological 
structure. 

I  have  already  pointed  out  in  another  paper  ("Remarks  on 
the  Histology  and  Pathological  Anatomy  of  Egyptian  Mummies," 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         83 

Cairo  Scientific  Journal,  Vol.  IV  [January,  1910],  No.  40)  how  often 
one  finds  evidence  of  disease  in  these  organs. 

INTESTINES 

I  have  examined  two  parcels  of  intestines  given  me  by  the 
authorities  of  the  Medical  School  in  Cairo.  The  interstices  be- 
tween the  intestines  were  filled  with  earth  and  sawdust,  and  I  had 
great  difficulty  in  removing  this  foreign  matter.  In  spite  of  every 
possible  care,  I  never  succeeded  in  unfolding  the  coils  of  the  intes- 
tines, and  I  am  still  unable  to  say  whether  the  whole  or  only  part 
of  the  intestines  was  placed  in  the  abdomen.  I  should  feel  inclined 
to  think,  however,  that  neither  of  these  parcels  contained  more  than 
half  the  length  of  the  intestines.  The  difficulty  was  increased  by 
the  fact  that  a  large  part  of  the  guts  in  one  case  had  been  trans- 
formed into  that  peculiar  substance  for  which  I  have  provisionally 
used  the  name  of  adipocere. 

Professor  Elliot  Smith  kindly  gave  me  some  small  pieces  of 
intestine.  In  Cairo  these  fragments  were  hard,  dry,  and  brittle, 
but  after  being  kept  a  few  weeks  in  the  moist  heat  of  my  laboratory 
at  Alexandria  during  the  summer,  they  became  somewhat  softer, 
more  pliable,  and  gave  off  a  distinctly  musty  odour. 

Small  pieces  swell  up  quickly  in  the  softening  solution,  and  the 
muscular  and  mucous  coats  are  then  recognised  even  with  the  naked 
eye,  though  under  the  influence  of  absolute  alcohol  all  differentiation 
disappears.  Microscopical  preparations  are  easily  obtained,  and 
the  various  layers  entering  into  the  formation  of  the  intestinal  walls 
are  distinctly  seen.  Plate  XXII,  Fig.  1,  is  an  exact  representation 
under  a  low  power  of  an  almost  complete  oblique  section  through 
the  walls  and  part  of  the  lumen  of  the  intestine.  At  (a)  the  annular 
muscular  coat  is  depicted.  The  longitudinal  coat  of  muscular  fibres 
is  well  preserved  also,  but  is  not  included  in  the  picture  so  as  to 
keep  the  latter  within  reasonable  limits.  The  submucous  tissue 
between  (a)  and  the  muscularis  mucosae  (b)  is  fairly  well  preserved, 
but  in  other  sections  it  is  altogether  absent.  The  muscularis 
mucosae  (b)  is  always  present  and  the  glandular  layer  when  exam- 
ined under  a  low  power  looks  like  an  open  meshwork.  The  lumen 
of  the  intestine  is  shown  bounded  by  a  thin,  dark  line,  which  doubt- 
less represents  the  layer  of  columnar  epithelium. 


84  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  lumen  of  the  intestine  is  always  empty  in  microscopical 
sections,  but  on  macerating  small  pieces  of  intestine  in  dilute  caustic 
potash  and  centrifugalising,  one  finds  in  the  centrifugalised  residue 
debris  of  partially  digested  muscular  fibres  and  vegetable  cells. 
In  one  case  I  saw  granules  which  gave  all  the  histological  reactions 
of  starch. 

Examination  under  a  high  power  is  instructive  also.  Plate 
XXII,  Fig.  3,  shows  part  of  a  section  passing  through  the  annular 
fibres.  The  longitudinal  striation  is  present;  but  in  the  process  of 
drying  the  fibres  shrank  greatly  and  most  of  them  did  not  expand 
again  to  their  natural  size  in  the  softening  solution.  The  result  is 
that  a  kind  of  reticulum  has  been  formed,  and  owing  to  the  deficient 
longitudinal  expansion,  the  fibres  remained  somewhat  angular. 

Plate  XXII,  Fig.  2,  represents  sections  of  part  of  the  glandular 
layer  of  the  intestines.  Generally  the  structure  is  typical,  but  here 
again,  owing  to  deficient  expansion,  the  glands  are  peculiarly 
angular.  I  thought  at  first  that  the  darkly  staining  strands  round 
the  lumina  of  the  tubes  were  composed  of  connective  tissue  only, 
but  further  examination  showed  that  they  really  consisted  of  dried 
epithelium  cells,  which  had  not  expanded  again.  They  resemble 
somewhat  the  insufficiently  swollen  epithelium  cells  of  some 
mummified  livers  and  kidneys. 

I  only  obtained  a  very  small  piece,  about  an  inch,  of  the  colon 
of  a  body  of  the  Hearst  collection,  in  which  I  saw  the  transverse 
and  longitudinal  muscular  fibres.  The  muscularis  mucosae  had 
apparently  completely  disappeared. 

On  opening  the  body,  the  intestines  were  all  found  lying  in  the 
abdominal  cavity  and  looked  exactly  like  brown  tissue  paper. 
They  were  removed  bodily,  and  when  placed  in  the  formol  and 
carbonate  of  soda  solution,  they  became  again  beautifully  soft. 
After  a  time,  although  slightly  yellowish  in  colour,  they  looked 
almost  normal.  They  were  found  to  be  empty  from  end  to  end. 
Microscopically  the  peritoneal  and  muscular  coats  were  readily 
demonstrated,  but  the  mucous  membrane  appeared  to  have  com- 
pletely disappeared. 

The  intestines  of  that  child  much  resembled  those  of  the  Roman 
child,  except  that  the  whole  rectum  and  large  intestine,  as  far  as 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         85 

the  top  of  the  sigmoid  flexure,  was  filled  by  an  enormous  mass  of 
material.  So  distended  was  the  rectum  that  it  filled  practically 
the  whole  of  the  pelvis.  It  is  difficult  to  believe  that  this  was  the 
normal  condition  of  things,  and  it  is  probable  that  there  had  been 
complete  intestinal  obstruction,  although  no  stricture  nor  cause  for 
that  obstruction  could  be  discovered.  The  rest  of  the  intestines 
were  quite  empty.  Microscopically  the  state  of  the  intestines  was 
exactly  that  of  the  Roman  child. 

My  friend  Mr.  A.  Lucas  kindly  analysed  the  contents  of  the 
rectum  for  me  and  found  the  following  chemical  composition: 

Per  Cent 

Fatty  matter 28.1 

Vegetable  tissue  (not  identified) 26.6 

Mineral  matter  (insoluble  in  water),  chiefly  phosphates    5 . 2 

Sodium  chloride 9.8 

Organic  matter  (soluble  in  water,  not  identified) 14 .  o 

Organic  matter  (soluble  in  alcohol,  not  identified) 16.3 

100.  o 

The  extraordinary  fact  is  the  amount  of  sodium  chloride,  which 
is  far  larger  than  is  usually  contained  in  faeces.  In  this  connection 
one  must  remember  that  this  salt  was  a  favourite  ingredient  of 
medicines  and  enemata  of  the  old  Egyptians. 

STOMACH 

I  have  only  examined  one  stomach  histologically.  It  was  as 
hard  as  stone  and  when  broken  across  showed  a  distinctly  resinous 
fracture.  Microscopically  the  muscular  coats  were  easily  seen, 
though  the  mucous  membrane  had  completely  disappeared.  This 
may  have  been  due  to  autodigestion  before  death.  (Plate  XIII, 
Fig.  1.) 

TESTICLES 

In  one  mummy  of  the  XXIst  Dynasty  the  left  testicle  could  not 
be  found  at  all,  and  its  place  was  filled  by  a  quantity  of  earth  which 
had  been  pushed  in  from  above.  Whether  it  was  really  absent 
during  life,  or  whether  it  had  been  torn  away  by  the  embalmer, 
I  could  not  make  out.  The  testicle  on  the  other  side  was  sur- 
rounded by  sawdust  and  earth,  and  it  was  only  with  the  greatest 


86  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

difficulty  that  I  found  part  of  it  together  with  shreds  of  the  cre- 
master  muscle.  The  microscopical  sections  obtained  are  repre- 
sented by  Plate  XVIII,  Fig.  6.  The  spermatozoa  and  other  cells 
had  entirely  disappeared  and  were  replaced  by  a  very  small  quantity 
of  a  yellowish,  almost  homogeneous  substance. 

In  the  Greek  mummy  before  mentioned  the  testicles  were  found, 
as  the  scrotum  had  not  been  packed  at  all.  They  were  very  badly 
preserved  and  all  that  could  be  made  out  for  certain  were  the  septa 
between  the  lobes.  Altogether  the  result  of  the  examination  of  the 
testes  was  not  very  satisfactory. 

MAMMARY   GLANDS 

The  mammary  glands  of  women  were  sometimes  not  packed  and 
therefore  lie  flattened  and  dried  against  the  chest  wall.  The  only 
mammae  I  examined  were  those  of  old  women  in  which  the  glan- 
dular structure  had  almost  wholly  disappeared.  The  alveoli  were 
recognisable  in  places,  the  epithelium  cells  forming  thin,  dark 
strands  lining  them.  Strangely  enough,  the  connective  tissue 
showed  beautiful  nuclei  (see  Plate  XXII,  Fig.  4). 


The  object  of  this  work  was  to  ascertain  the  state  of  preservation 
of  mummies,  with  the  ulterior  object  of  studying  pathological 
changes  histologically.  The  question  now  arises,  whether  one  is 
justified  in  hoping  that  histological  methods  are  likely  to  be  of 
assistance  in  the  elucidation  of  the  pathology  of  ancient  Egyptians. 
My  studies  show  that  the  general  arrangement  of  the  anatomical 
elements  entering  into  the  formation  of  tissues  and  organs  of  mum- 
mies of  the  XXIst  Dynasty,  and  of  dried  bodies,  is  well  preserved, 
as  the  chief  microscopical  characteristics  of  the  skin,  breast,  lungs, 
liver,  kidneys,  testicles,  heart,  intestines,  stomach,  blood  vessels, 
and  muscles  are  easily  recognised.  Indeed,  none  of  my  numerous 
competent  visitors  had  any  difficulty  in  diagnosing  from  what 
organs  the  microscopical  slides  shown  to  them  had  been  prepared. 
On  the  other  hand,  however,  many  cells  have  undergone  important 
alterations;  and  the  nuclei,  for  instance,  can  no  longer  as  a  rule  be 
differentiated  by  staining  methods.     There  are  exceptions  to  this 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         87 

rule,  for  some  nuclei  are  noticeable  still,  as  in  the  epidermic  layer 
of  the  skin,  the  connective  tissue  of  the  female  breast,  the  adenoid 
tissue  of  the  intestine,  and  the  cells  of  some  livers  and  kidneys. 
Moreover,  there  is  reason  to  think  that  the  nuclei  are  really  better 
preserved  than  I  imagined  and  that  an  improved  technique  will 
reveal  their  presence  more  often. 

The  histological  details  of  the  cells  of  most  organs  have  also 
almost  entirely  vanished;  this  is  specially  well  marked  in  the  liver 
and  kidneys,  where  the  individual  cells  are  often  undistinguishable. 
On  the  other  hand,  the  histological  characteristics  of  certain  blood 
vessels,  of  the  nerves,  of  the  heart,  and  especially  of  muscle,  are 
surprisingly  well  preserved. 

I  think  therefore  that  the  microscopical  examination  of  mum- 
mies may  reveal  changes  due  to  infiltration  of  tissues  by:  (1) 
new  growths,  (2)  infective  granulomata,  (3)  animal  and  vegetable 
parasites,  (4)  inflammation,  (5)  proliferation  of  connective  tissue 
(cirrhosis),  (6)  atheroma  and  calcification,  but  that  there  is  little 
hope  of  recognising  diseases  in  which  the  chief  lesions  are  seen  in 
the  cells  of  organs  and  tissues. 

An  attempt  may  now  be  made  to  answer  another  question, 
partly  at  any  rate.  Does  the  histological  structure  of  mummies 
give  any  indication  with  regard  to  the  method  of  preservation  of 
the  body  and  organs  in  the  XXIst  Dynasty  ? 

In  describing  the  blood  vessels,  I  drew  attention  to  the  fact  that 
as  several  hours  elapsed  between  the  time  of  death  and  the  removal 
of  the  organs  from  the  body,  a  certain  amount  of  decomposition 
must  necessarily  have  taken  place. 

When  enumerating  the  details  of  the  histology  of  the  skin,  the 
difference  in  the  state  of  preservation  between  the  skin  of  the  trunk 
and  that  of  the  extremities  was  insisted  on.  This  difference  is 
probably  due  to  cadaveric  putrefaction,  always  beginning  earlier 
and  being  more  marked  in  the  trunk  than  in  the  extremities. 

The  exact  nature  of  the  pickling  solution  has  not  been  ascer- 
tained, but  I  feel  inclined  to  think  it  contained  a  large  quantity  of 
chloride  of  sodium. 

Strong  solutions  of  chloride  of  sodium  have  a  light  macerating 
action,  and  the  salt  extracting  water  from  the  tissues  causes  the 


88  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

latter  to  shrink,  and  diminishes  or  even  abolishes  putrefaction. 
Indeed,  chloride  of  sodium  has  been  used  from  time  immemorial 
for  preserving  foodstuff.  On  the  other  hand,  natron  is  used  in 
histology  chiefly  for  the  preparation  of  alkaline  solutions  of  dyes, 
and  for  the  maceration  of  tissues.  A  weak  solution  of  such  a  salt 
would  not  preserve  tissues,  while  a  strong  one  would  macerate  them 
past  all  recognition. 

It  appears  to  me  probable  that  the  solution  used  was  one  of 
"natron,"  but  that  this  "natron"  consisted  chiefly  of  sodium 
chloride  with  a  small  admixture  of  carbonate  and  sulphate  of  soda. 
It  would  be  interesting  to  ascertain  whether  samples  of  "natron" 
with  such  a  chemical  composition  are  still  to  be  found  in  Egypt. 

After  the  organs  were  removed  from  the  pickling  bath,  the  dry- 
ness of  the  atmosphere  alone  probably  sufficed  in  some  cases  to 
preserve  the  organs  indefinitely.     Mr.  Quibell  writes: 

Bodies  in  an  extraordinarily  good  state  of  preservation,  dried  and  very 
light,  but  with  the  skin  complete  and  flesh  dried  in  whisps  (something  like 
Bombay  duck)  have  been  found  in  archaic  cemeteries  by  many  people  (myself 
among  them) ,  and  as  far  as  I  know,  there  is  no  proof  of  a  preservative  having 
been  used. 

I  have  myself  seen  in  the  desert  of  Sinai  the  hind  quarters  of  a 
camel  in  a  perfect  state  of  preservation,  having  been  simply  dried 
by  the  sun.  The  desiccation  in  this  case  must  have  taken  place 
rapidly,  as  otherwise  the  flesh  would  certainly  have  been  eaten  by 
the  few  leopards  and  the  many  hyenas  and  jackals  which  roam 
about  the  desert. 

What  share  these  various  processes  had  respectively  in  producing 
the  described  result,  we  can  only  guess.  Probably  the  most  powerful 
factor  in  preventing  decomposition  was1  the  dryness  of  the  climate. 
The  tombs,  where  most  of  the  bodies  were  discovered,  are  rock-hewn 
tombs  and  far  above  the  level  of  the  Nile  flood.  The  heat  during 
the  day,  even  in  winter,  is  intense,  and  though  the  nights  are  often 
very  cold,  nevertheless  the  climate  throughout  the  year  is  always 
dry,  the  rainfall  being  almost  nil.  It  seems  quite  evident  that 
incipient  putrefaction  would  be  arrested  very  soon  for  want  of 
water. 

1  The  following  remarks  apply  only  to  such  mummies  as  have  been  studied  in 
this  paper  and  not  to  all  Egyptian  mummies. 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES         89 

Desiccation  alone,  however,  would  not  account  for  the  good 
state  of  preservation  of  mummies  removed  to  the  hot,  steamy 
atmosphere  of  Lower  Egypt.  In  such  cases  the  acid  reaction  and 
the  packing  of  mud  and  sawdust  would  absorb  all  moisture  and 
prevent  putrefaction.  It  must  be  remembered  also  that  under 
certain  circumstances  mummified  organs  undergo  putrefaction. 
Thus,  pieces  of  intestine  removed  to  Alexandria  gave  off  a  musty 
odour  and  when  suspended  in  dilute  alkalies  proved  a  good  cultivat- 
ing medium  for  bacteria.  A  dried  head  which  I  bought  at  Luxor 
and  which  was  there  quite  sweet,  became  putrid  in  Lower  Egypt. 
Mr.  Quibell  writes:. 

I  have  found  a  body  of  the  Old  Empire  in  a  state  of  putrefaction  and  very- 
unpleasant.  The  body  had  dried  rapidly  and  been  preserved  for  many  cen- 
turies until  the  rise  of  the  level  of  the  country,  or  exposure  to  damp  from 
showers  after  some  denudation  of  the  surface,  had  started  the  process  of  decay 
again. 

On  the  other  hand,  human  bodies  when  once  well  dried  may  be 
exposed  to  the  atmosphere  for  considerable  periods  without  putre- 
faction taking  place.  I  have  in  my  laboratory  the  body  of  a  Roman 
child  which  had  been  simply  dried  in  the  sand.  This  has  remained 
quite  sweet;  the  only  change  that  has  taken  place  in  a  period  of 
more  than  a  year  is  that  the  skin  has  become  softer  and  somewhat 
soapy  to  the  touch.  The  strange  part  of  it  is  that  no  insects  (ants, 
etc.)  have  attacked  it.  The  temperature  of  this  laboratory  varied 
between  560  and  ioo°  F. ;  for  four  months  it  seldom  went  below 
75°  F.  and  was  generally  above  8o°  F.  In  the  summer  the  air  was 
saturated  with  humidity. 

The  methods,  therefore,  used  by  the  Egyptians  of  the  XXIst 
Dynasty  for  preserving  the  bodies  of  their  friends  were  of  the  sim- 
plest; namely,  pickling  in  salt  solution  and  filling  up  with  sand  or 
mud  to  absorb  moisture.  These  methods  were  sufficient  to  preserve 
the  histological  structure  of  the  tissues. 

The  observations  on  which  this  paper  is  based  were  made  more 
than  two  years  ago.  Dr.  Willmore  showed  some  of  the  sections  at 
the  British  Medical  Association  in  July,  1908,  and  I  demonstrated 
them  at  a  meeting  of  the  Cairo  Scientific  Society  in  December  of 
the  same  year. 


90  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  paper  and  the  illustrations  accompanying  it  were  finished 
more  than  one  year  ago,  but  the  publication  was  delayed  until  the 
Institut  Egyptien  very  generously  offered  to  bear  the  greater  part 
of  the  expense.  I  may  be  permitted,  therefore,  to  offer  my  best 
thanks  to  the  members  of  the  Institut  for  their  kindness  and 
generosity. 

The  delay  has  been  in  some  measure  an  advantage.  It  has 
enabled  me  to  control  my  work  over  and  over  again,  and  I  have 
found  no  reason  to  alter  this  account  of  my  observations.  Indeed, 
the  hope  expressed  in  this  paper  that  histological  investigations 
would  add  to  our  knowledge  of  the  pathology  of  ancient  Egypt  has 
since  been  fulfilled. 

DESCRIPTION  OF  PLATES  XII-XXTP 

(For  all  particulars  see  text) 

plate  xn 

Fig.  i. — Liver,  drawn  exactly  natural  size,  from  actual  measurements. 
The  liver  is  folded  upon  itself  and  contains  in  the  cavity  so  formed  a  statuette 
of  the  human-headed  Amset. 

Fig.  2. — Liver  (drawn  exactly  to  scale)  seen  in  profile. 

plate  xm 

Fig.  i. — Part  of  stomach,  drawn  natural  size.     It  was  packed  in  sawdust. 

Fig.  2. — Stomach.  Fracture  showing  resinous  surface,  though  it  contained 
no  resin. 

Fig.  3. — Fractured  surface  of  skin  of  chest  and  subjacent  muscle.  It  has 
a  resinous  appearance,  though  it  contained  no  resin  whatever. 

Fig.  4. — Roll  of  intestines.  Drawn  from  measurement  and  reduced  to 
f  size.    It  contains  a  small  figure  of  the  hawk-headed  Khebsennuf. 

PLATE  XIV 

Fig.  1. — Lung,  drawn  natural  size.    The  lung  has  been  dried  flat. 
Figs.  2  and  3. — Heart  natural  size.    Anterior  and  posterior  surfaces. 

PLATE  xv 

Fig.  1. — Nerve  of  finger.  Haematoxylin.  The  medullary  sheath  is  well 
seen.     (Leitz,  Oc.  1,  Xi/12.) 

Fig.  2. — Another  section  of  nerve.  Two  axis  cylinders  are  seen.  Same 
staining  and  magnification  as  preceding  one. 

'The  figures  are  from  mummies  of  the  XXIst  Dynasty,  unless  othewise  stated. 


HISTOLOGICAL  STUDIES  ON  EGYPTIAN  MUMMIES  91 

Fig.  3. — Skin  of  finger.  Sweat  glands  are  evident.  Nuclei  are  seen  also. 
Eosin.     (Leitz,  low  power.) 

Fig.  4. — Kidney.  The  epithelium  cells  have  been  converted  into  a  yellow 
homogeneous  substance.    Haematoxylin.     (Leitz,  Oc.  1,  Xi/12.) 

PLATE  XVI 

Fig.  1. — Skin  of  finger.  Haematoxylin.  Notice  how  well  the  nuclei  have 
been  preserved.     (Leitz,  Oc.  1,  Xi/12.) 

Fig.  2. — Skin  of  chest.  Notice  contrast  with  preceding  one,  almost  all 
the  epithelium  cells  having  disappeared.  Some  of  the  packing  material  is 
still  adherent  to  the  surface,  (a)  packing  material;  (b)  corium;  (c)  sub- 
cutaneous tissue.     Haematoxylin.     (Leitz,  low  power.) 

Fig.  3. — Skin  of  finger.  Transverse  section  of  sweat  glands.  Nuclei  still 
visible.     (Leitz,  Oc.  1,  Xi/12.) 

Fig.  4. — Epidermic  cells  of  the  skin  floated  off  after  maceration.  Haema- 
toxylin.    (Leitz,  Oc.  1,  Xi/12.) 

Fig.  5. — Section  through  a  nerve.     (Low  power.) 

Fig.  6. — From  the  subcutaneous  tissue  of  a  body  (not  mummified  but 
dried  in  the  sand)  about  8000  B.C.  No  anatomical  structure  recognisable 
except  nuclear  masses  staining  with  haematoxylin  (nuclei).  (Leitz,  Oc.  1,  X 
1/12.) 

Fig.  7. — Subcutaneous  tissue  of  mammary  gland.  Haematoxylin.  (Leitz, 
Oc.  1,  Xi/12.) 

PLATE   XVII 

Fig.  1. — Small  digital  nerve.    Haematoxylin.     (Leitz,  low  power.) 

Fig.  2. — Teased  muscle  of  arm,  mounted  in   Canada  balsam.     Eosin. 

(Leitz,  Oc.  1,  Xi/12.) 

Fig.  3. — Somewhat  diagrammatic  representation  of  muscle  fibre  teased 

in  normal  salt  solution.    At  (a)   the  sarcolemma  is  visible.     (Leitz,  Oc.  1, 

Xi/12.) 

PLATE  XVIXI 

Fig.  1. — Small  renal  vessel.    Eosin.     (Leitz,  Oc.  1,  Xi/12.) 
Fig.  2. — Large  vessel  of  neck  in  very  bad  state  of  preservation.     Eosin. 
(Leitz,  Oc.  1,  Xi/12.) 

Fig.  3. — Middle  coat  of  aorta.     Eosin.     (Leitz,  Oc.  1,  Xi/12.) 
Fig.  4. — Small  digital  artery.     All  the  coats  of  artery  can  be  seen.     Hae- 
matoxylin.    (Leitz,  Oc.  1,  Xi/12.) 

Fig.  5. — Cartilage  cells  of  the  trachea.  At  (a)  two  cartilage  cells  in  same 
space.    At  (b)  the  nuclei  are  still  seen.     Eosin.     (Leitz,  Oc.  1,  Xi/12.) 

Fig.  6. — Testicle.  The  spermatozoa  have  entirely  disappeared.  Haema- 
toxlin.     (Leitz,  Oc.  1,  Xi/12.) 


92  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

PLATE  XIX 

Fig.  i  . — Liver  in  which  nothing  can  be  seen  but  a  thin  reticulum.  Haema- 
toxylin.     (Leitz,  Oc.  i,  Xi/12.) 

Fig.  2. — Liver,  better  preserved  than  the  last.  Haematoxylin.  (Low 
power.) 

Fig.  3. — Liver,  showing  rows  of  cells  and  central  vessel  at  (a)  with  shreds 
of  vessel  wall.     Haematoxylin.     (Leitz,  Oc.  1,  Xi/12.) 

Fig.  4. — Well-preserved  liver  cells  showing  nuclei.  Haematoxylin.  (Leitz 
Oc.  1,  Xi/12.) 

PLATE   XX 

Fig.  i. — Lung.     Eosin.     (Leitz,  Oc.  1,  Xi/12.) 
Fig.  2. — Another  lung.    Haematoxylin.     (Low  power.) 
Fig.  3. — Section  of  another  lung;    alveoli  greatly  distended  and  full  of 
foreign  material.     Eosin.     (Leitz,  Oc.  1,  Xi/12.) 

PLATE   XXI 

Fig.  i. — Section  of  cortex  of  kidney  showing  tubuli  contorti  and  glomer- 
uli. Haematoxylin.  (Low  power.)  The  dark  spots  in  the  glomeruli  are  not 
nuclei,  but  irregular,  more  darkly  stained  shreds  of  tissue. 

Fig.  2. — Epithelium  layer  of  tubuli  contorti,  very  highly  magnified. 
(Leitz,  Oc.  3,  Xi/12.) 

Fig.  3. — Straight  tubules.     (Low  power.) 

Fig.  4. — Glomerulus.     (Zeiss,  Oc.  3,  Xi/12.) 

Fig.  5. — Connective  tissue  of  kidney,  from  which  epithelium  has  been 
washed  out.     (Low  power.) 

PLATE  XXII 

Fig.  1. — Section  of  fold  of  intestine.  Haematoxylin.  (Low  power.)  (a) 
muscular  coat;  (b)  submucous  layer;  (c)  glandular  layer  and  muscularis; 
(d)  lumen  of  intestine.  At  (a)  in  the  lower  part  of  the  intestine  the  muscular 
layer  has  become  kinked  and  folded  on  itself.  The  artist  faithfully  reproduced 
what  he  saw,  and  I  thought  it  preferable  not  to  retouch  the  picture  in  any  way. 

Fig.  2. — Oblique  section  through  glandular  layer  of  intestine,  (a)  glands; 
(b)  part  of  submucosa  showing  nuclei.     (Leitz,  Oc.  1,  Xi/12.) 

Fig.  3. — Smooth  muscles  of  intestine.     (Leitz,  Oc.  1,  Xi/12.) 

Fig.  4. — Connective  tissue  of  breast  of  woman  showing  nuclei.  (Leitz, 
Oc.  1,  Xi/12.) 


PLATE  XII 


-.-  :--:  "~$:-  . 


PLATE  XIII 


»*. 


V 


PLATE  XIV 


Fig.  3 


PLATE  XV 


Fig.  3 


Fic.  2 


F i 


PLATE  XVI 


I-     . 


PLATE  XVII 


PLATE  XVIII 


Fig.  2 


Fig.  3 


Fig.  4 


Fig.  3 


Fie.  4 


Fic.  2 


PLATE  XX 


¥hmwA 


•      ••  ~-   ■■     '".-  '*'•»•    „*.:      ^  ' 


PLATE  XXI 


.^   ** 


**"         .AT*- 


Fig.  i 


I  ■!■..     j 


Fig.  4 


I  [I 


PLATE  XXII 


I  [C.    | 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS1 
{Journal  oj  Pathology  and  Bacteriology,  Vol.  XVI  [191 2]) 

In  1907  the  Egyptian  Government  decided  to  make  an  archaeo- 
logical survey  of  that  part  of  Nubia  which  would  be  flooded  more  or 
less  permanently  when  the  Assuan  dam  was  raised.  Dr.  Elliot 
Smith,  at  first  alone,  afterwards  in  collaboration  with  Dr.  Wood 
Jones  and  Dr.  Derry,  was  entrusted  with  the  anthropological  side 
of  the  inquiry,  and  the  results  of  the  exploration  were  published  in 
the  Bulletins  of  the  Archaeological  Survey  of  Nubia.  It  is  not  too 
much  to  say  that,  quite  apart  from  archaeological  contributions, 
the  anatomical  and  pathological  discoveries  fully  justified  the 
expenditure  necessary  for  this  work. 

This,  as  far  as  we  know,  was  the  first  systematic  investigation 
regarding  the  diseases  of  old  Egyptians. 

As  early  as  1889,  however,  our  friend  Dr.  Fouquet  published 
several  observations  on  pathological  specimens  found  in  Egyptian 
tombs.2  Although  we  are  very  far  from  invariably  agreeing  with 
this  observer's  diagnoses  and  conclusions,  yet  he  has  the  un- 
doubtedly great  merit  of  having  been  a  pioneer  in  this  branch  of 
science. 

Lastly,  a  new  department  of  pathological  research  was  opened 
up  when  one  of  us  (M.  A.  R.)  studied  the  histology  of  Egyptian  mum- 
mies and  shortly  described  the  pathological  alterations  seen  under 
the  microscope. 

Before  entering  into  the  main  part  of  our  paper,  we  should  like 
to  add  that  surely  the  time  has  come  when  a  check  should  be  put 
on  the  wholesale  destruction  of  the  pathological  specimens  of  the 
past,  which  has  been  going  on  for  over  one  thousand  years.3  Hun- 
dreds of  mummies  and  dried  human  corpses  have  been  removed 

■  This  paper  was  written  with  A.  Rietti  as  junior  author. 

2  Mimoircs  publies  par  les  membres  de  la  Sociele  Archeologique  FraiiQaise  au  Cake 
sous  la  direction  de  M.  Maspero,  1881-84,  fasc.  4.  Also,  De  Morgan,  Rechcrches  sur 
les  origines  de  I'&gypte. 

•>  Mummies  were  exported  from  Egypt  right  through  the  Middle  Ages. 


94  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

from  Egyptian  tombs,  and,  with  the  exception  of  the  facts  enumer- 
ated in  the  papers  above  mentioned,  there  exist  only  a  few  very 
imperfect  records  of  the  state  of  these  bodies.  We  hope  and  urge 
that  the  authorities  will  prohibit  the  exportation  of  skeletons,  dried 
remains,  or  mummies  until  these  have  been  examined  by  experts. 
Unless  this  is  done  soon,  the  present  waste  of  scientific  material  will 
continue,  only  to  be  bitterly  regretted  before  long. 

Sir  Gaston  Maspero,  Professor  Flinders  Petrie,  Dr.  Keatinge, 
and  Professor  Breccia  have  placed  at  our  disposal  a  number  of 
mummies  and  skeletons,  dating  from  various  periods  of  ancient 
Egypt.  These  we  have  examined  macroscopically,  and,  whenever 
possible,  microscopically.  The  best  pathological  specimens  will  be 
deposited  in  the  Museum  of  the  Medical  School  at  Cairo,  but  a 
large  number  of  diseased  bones  will  remain  over,  which  will  be  sent 
to  any  recognised  pathological  institute,  for  study  and  comparison 
with  examples  of  the  same  disease  occurring  at  the  present  time. 

Our  material  came  partly  from  Upper  Egypt  and  partly  from 
Alexandria.     A  few  words  about  the  latter  are  necessary. 

At  Chatby,  near  Alexandria,  about  two  minutes'  walk  from  the  sea,  lie 
the  tombs  of  the  Macedonian  soldiers  of  Alexander  the  Great  and  Ptolemy  I. 
In  view  of  the  constant  growth  of  the  town,  which  will  soon  extend  over  the 
whole  of  this  region,  the  Municipal  Commission  ordered  an  archaeological 
survey  of  this  site.  The  work  was  entrusted  to  Professor  E.  Breccia,1  the 
curator  of  the  Alexandria  Museum,  who  gave  us  permission  to  examine  most 
of  the  bones  found  in  the  necropolis  and  to  be  present  during  some  of  the 
excavations.  Owing  to  a  lawsuit,  the  work  has  been  suspended  for  a  time, 
and  this  delay  is  specially  unfortunate  because  the  names  on  the  tombs  to  be 
yet  opened  indicate  that  the  crypts  contain  the  skeletons  of  the  prostitutes 
who  accompanied  the  Greek  army.  Here,  if  anywhere,  evidences  of  syphilis 
and  gonorrhoea  should  be  found,  provided  always  venereal  disease  existed  at 
that  period. 

The  bodies  had  been  placed  in  rock-hewn  graves.  The  first  grave  was  an 
ossarium  measuring  about  2  cm.,  and  filled  with  sand  and  bones,  and  closed 
with  a  stone  slab  which  had  been  hermetically  sealed  with  mortar.  The  bones, 
after  the  bodies  had  undergone  decomposition  elsewhere,  had  been  thrown 
into  the  ossarium  pele-mele,  and  little  care  had  been  taken,  as  among  the  human 
bones  the  femur  of  a  horse  was  found. 

1  This  eminent  archaeologist  will  soon  publish  a  full  account  of  his  researches, 
which  will  throw  much  light  on  the  habits  of  the  Greek  immigrants  in  Egypt. 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  95 

The  other  sepulchres  were  horizontal  shafts,  3.5  feet  high,  6  feet  deep,  and 
about  3.5  feet  wide,  cut  in  the  solid  rock  and  closed  in  the  same  manner  as 
the  ossarium.  Very  rarely  such  a  tomb  contained  but  one  body  lying  on  a 
layer  of  sand  about  6  inches  deep;  as  a  rule,  several  skeletons,  five,  six,  or 
even  more,  were  present.  The  small  size  of  the  shafts  proved  that  the  bodies 
were  not  put  in  together,  but  that  the  first  had  been  allowed  to  putrefy  and 
fall  to  pieces  before  the  second  was  introduced. 

Funereal  urns  filled  with  ashes  or  half-carbonised  bones  were  discovered 
also.  The  Greeks  of  that  period,  therefore,  were  eclectic  in  their  customs,  some 
families  burning,  others  burying  their  dead. 

Unfortunately,  the  level  of  the  land  has  sunk  several  feet  since  the  last 
body  was  consigned  to  the  grave.  Hence  some  tombs  were  partially  filled, 
others  merely  infiltrated,  with  sea  water,  and  the  bones  were  often  found  lying 
in  water  or  thick,  wet  mud.  Such  skeletons  were  in  very  bad  condition,  and 
most  of  the  smaller  and  some  of  the  larger  bones  could  not  be  found,  even 
when  the  slush  was  removed  carefully  by  hand. 

Although,  as  might  be  expected,  the  bones  were  rather  better  preserved 
in  dry  than  in  wet  graves,  yet  this  was  by  no  means  the  rule.  The  skeleton 
of  a  female,  for  instance,  lying  on  a  bed  of  dry  sand  was  so  fragile  that  some 
bones  were  broken  when  their  removal  was  attempted;  on  the  other  hand, 
bones  lying  in  liquid  mud  were  sometimes  very  hard,  whereas  .others,  in  the 
same  grave,  broke  as  soon  as  touched. 

Sometimes  the  soldiers  had  been  buried  with  their  wives  and  children. 
Nothing  could  be  learned  from  the  skeletons  of  the  latter,  as  hardly  a  single 
bone  was  preserved  sufficiently  well  for  examination. 

We  shall  not  enter  into  anthropometric  details,  as  the  skeletons  have  been 
handed  over  to  an  anthropologist  for  examination.  We  may  say,  however, 
that  a  superficial  examination  sufficed  to  show  that  various  races  were  repre- 
sented. Of  the  thirty-two  skulls  examined,  some  had  high-bridged  noses, 
others  remarkably  flat  ones.  Some  were  brachycephalic,  others  markedly  doli- 
chocephalic; two  skulls  were  evidently  negroid.  The  variations  in  stature 
were  great  also,  some  men  being  very  tall,  others  short.  These  differences 
are  not  to  be  wondered  at,  considering  that,  from  the  start,  Alexander's  army 
was  distinctly  a  "mixed  crew."  It  is  stated,  for  instance,  in  Smith's  Classical 
Dictionary  that  of  the  30,000  foot  soldiers  who  left  Greece  with  Alexander, 
only  12,000  were  Greeks;   the  others  were  foreigners,  Thracians  chiefly. 

The  inscriptions  on  the  tombs  are  in  Greek,  but  it  is  highly  probable  that 
the  soldiers  settled  in  Egypt  had  intercourse  with  and  often  married  native 
women,  just  as  their  successors  have  done  in  modern  times.  The  present 
Berberine,  for  instance,  especially  when  coming  from  Korosko,  often  boasts  that 
he  is  a  descendant  of  a  Turkish  soldier  and  a  native  woman.  The  term  Turk, 
as  used  by  him,  includes  Greek,  Hcrzcgovinian,  Bosnian,  Bulgarian,  and 
Servian. 


96  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Part  of  our  material  is  derived  from  the  catacombs  of  Kom  el  Shougafa, 
which  are  situated  close  to  Pompey's  Pillar  at  Alexandria,  and,  according  to 
Professor  Breccia,  the  bodies  date  from  the  second  century  after  Christ.  The 
tombs  contain  hundreds  of  skeletons,  most  of  which,  owing  to  the  gradual 
infiltration  of  water,  are  in  such  a  bad  condition  that  they  cannot  be  examined. 
The  few  seen  by  us  were  in  two  tombs  in  which  the  damp  had  not  penetrated. 

It  has  been  supposed  that  these  catacombs  contained  the  skeletons  of  the 
Alexandria  youths  who  were  massacred  by  order  of  Caracalla.  A  simple 
examination  of  the  skeletons  showed  this  supposition  to  be  wrong,  as  the 
bones  are  those  of  men,  women,  and  children. 

On  the  whole,  the  mode  of  burial  was  almost  identical  with  that  seen  at 
Chatby.  The  first  body  had  been  placed  on  a  layer  of  sand  about  4  inches 
high,  and  later  on  the  skeleton  had  been  pushed  aside  to  make  room  for  the 
second  occupant.  The  size  of  the  tombs  precluded  all  possibilities  of  more 
than  two  or  three  bodies  having  been  buried  at  one  time.  So  far  we  have 
not  come  across  any  sign  of  cremation  whatever. 

We  have  also  examined  five  Coptic  bodies  coming  from  Upper  Egypt  and 
dating  from  the  fifth  century  a.d. 

OLD  EGYPTIAN  SKELETONS 

I.       SPONDYLITIS   DEFORMANS,    FRACTURE    OF    THE    LEFT   FIRST    RIB, 

SLIGHT   ARTHRITIS,   IN   A   SKELETON   OF   THE   THIRD  DYNASTY 

(2980-29OO   B.C.) 

This  skeleton,  that  of  a  man  called  Nefermaat,  was  found  by 
Mr.  G.  Wainwright.1  We  are  greatly  obliged  to  Professor  W.  M. 
Flinders  Petrie  for  allowing  us  to  describe  the  pathological  lesions.2 

The  bones  are  extremely  fragile,  and  were  covered  in  many 
places  with  thick  incrustations  of  salt.  At  some  time  or  other  they 
had  been  buried  in,  or  at  any  rate  been  in  intimate  contact  with, 
earth,  as  many  of  the  spinal  foramina  were  still  filled  with  mud. 

The  spinal  column  from  the  fourth  cervical  to  the  coccyx,  and 
possibly  through  its  whole  length,  had  been  converted  by  disease 
into  one  rigid  block.  This  had  been  broken  into  several  pieces  after 
death  (Plate  XXIII,  Figs.  2-5). 

Atlas,  axis,  and  third  cervical  vertebra  absent.  Fourth  to  sixth  cervical 
and  first  dorsal  vertebrae  form  a  rigid  pillar,  being  firmly  ankylosed  anteriorly 
by  solid  new  bone  (Plate  XXIII,  Fig.  2),  evidently  formed  in  anterior  spinous 

1  Gerald  Wainwright,  "The  Mastaba  of  Nefermaat,"  in  Meydoum  and  Memphis 
(3),  by  W.  M.  Flinders  Petrie,  Ernest  Mackay,  and  Gerald  Wainwright,  1910,  p.  18. 

2  This  skeleton  will  now  be  placed  in  the  Cairo  collection. 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  97 

ligament.  Distinct  bulging  of  this  osseous  bridge  opposite  each  space  for 
intervertebral  disc.  Through  gaps  one  can  see  that  intervertebral  discs  were 
not  ossified,  as  surfaces  of  vertebrae  are  perfectly  smooth.  Space  for  inter- 
vertebral discs,  though  empty,  are  not  narrowed. 

Posterior  spinous  ligament  completely  ossified.  New  bone,  however,  does 
not  bulge  into  spinal  canal,  which  therefore  was  not  narrowed  by  bone. 

Superior  surface  of  fourth  cervical  vertebra  had  suffered  much  injury  post 
mortem.  Inferior  border  of  body  of  first  dorsal  shows  numerous  osteophytes, 
forming  a  bridge  with  like  prolongations  on  superior  border  of  second  dorsal 
below. 

Whole  dorsal  region  displays  similar  lesions  (Plate  XXIII,  Fig.  4),  both 
anterior  and  posterior  borders  of  vertebral  bodies  being  firmly  ankylosed. 
Articulating  surfaces  with  few  exceptions  united  solidly.  Spinous  processes, 
when  present,  normal,  save  eleventh  and  twelfth,  which  are  united  by  strong 
bony  bridge. 

Similar  alterations  in  lumbar  region,  where,  however,  posterior  spinous 
ligament  is  not  ossified.  The  right  vertebral  groove  opposite  the  twelfth 
dorsal,  first  and  second  lumbar  vertebrae  filled  with  mass  of  somewhat  spongy 
bone  about  3  cm.  broad,  extending  laterally  over  articulating  surfaces  (Plate 

XXIII,  Fig.  5)  which  are  everywhere  covered  with  thick  new  bone.  Similar 
but  smaller  mass  occupies  the  same  situation  on  left  side  (Plate  XXIII, 
Fig.  1). 

Fifth  lumbar  vertebra  is  firmly  ankylosed  with  the  sacrum,  which  is  com- 
pletely ossified  and  otherwise  normal. 

Acelabula  normal,  except  for  some  small  osteophytes  at  junction  of  articular 
and  non-articular  parts. 

Left  femur. — Head  broken  off  post  mortem.  Slight  deposit  of  new  bone 
at  junction  of  head  and  neck. 

Right  femur. — Slight  thickening  on  anterior  border  of  articulating  surface 
of  knee-joint. 

Scapulae. — Very  slight  roughening  round  scapulo-humeral  articulations. 

Manubrium  stemi  shows  curious  lesions.  On  right  side  there  is  a  pro- 
longation of  bone,  evidently  part  of  the  first  rib  firmly  ankylosed  with  manu- 
brium sterni  (Plate  XXIV,  Fig.  6).  This  ends  in  a  smooth,  rounded  surface 
which  evidently  was  an  articulating  surface.  We  suggest  that  at  some  time 
or  other  there  had  been  a  fracture  of  the  first  rib,  which  had  healed  badly, 
and  that  a  false  joint  had  formed. 

That  the  costal  cartilages  had  been  extensively  ossified  is  shown  by  Plate 

XXIV,  Fig.  7,  representing  the  rest  of  the  sternum. 

In  the  bones  of  the  skull  which  were  left,  nothing  particular  was  found 
except  that  the  internal  surface  of  both  condyles  were  rough  and  showed 
distinct  signs  of  inflammation. 

Left  parietal  bone  extensively  gnawed  by  insects. 


98  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

II.      SPONDYLITIS    DEFORMANS    AND    OSTEO-ARTHRITIC    LESIONS     OF 

THE   HAND   IN   A   SKELETON   OF   THE   THLRD   DYNASTY 

(2980-29OO   B.C.) 

These  bones,  found  by  Professor  W.  M.  Flinders  Petrie  in  a 
tomb  of  the  Illrd  Dynasty  near  the  Fayoum  pyramid,  belonged  to 
an  adult  of  small  size,  whose  age  and  sex  cannot  be  estimated. 
Although  few  [in  number,  they  are  worth  describing  owing  to  the 
intensity  of  the  pathological  changes  in  them. 

Atlas. — Some  osseous  overgrowth  at  point  of  attachment  of  transverse 
ligament,  specially  on  left  side,  where  new  bone  forms  a  kind  of  cushion  about 
7  mm.  long  and  1  mm.  thick.     On  left  side  a  spear-shaped  osteophyte  about 

4  mm.  long,  3  mm.  broad,  and  3  mm.  thick  projects  upwards  from  anterior  arch 
(Plate  XXIV,  Fig.  13).  Tubercle  on  the  anterior  arch  greatly  thickened. 
Superior  articular  surfaces  smooth. 

Axis. — Odontoid  process  very  irregular  and  capped  by  an  osteophyte  quite 

5  mm.  long.  Inferior  anterior  border  prolonged  into  thick  spear-shaped  point 
(Plate  XXIV,  Fig.  16).    Articulating  surfaces  smooth. 

Cervical  vertebra  (fourth?). — Great  thickening,  round  body,  especially 
anteriorly  (Plate  XXIV,  Fig.  10).  Inferior  anterior  border  sends  off  thick 
prolongation  downwards.  Judging  from  the  worm-eaten  and  rough  appearance 
of  the  body,  it  would  appear  that  the  disease  possibly  extended  to  the  inter- 
vertebral discs  ( ?) . 

Two  cervical  vertebrae  firmly  joined  by  ossified  anterior  and  posterior 
spinous  ligaments  (Plate  XXIV,  Fig.  12).  The  disease  has  not  extended  to 
transverse  processes. 

Two  separate  dorsal  vertebrae. — Both  show  much  thickening  on  anterior  and 
lateral  borders,  where  new  bone  measures  as  much  as  4  mm.  thickness  (Plate 
XXIV,  Figs.  8  and  11). 

First  lumbar  vertebra. — Mass  of  new  bone  8  mm.  thick,  on  left  superior 
lateral  border  (Plate  XXIV,  Fig.  9). 

One  metatarsal  bone  shows  distinct  thickening  at  both  ends  (Plate  XXIV, 
Fig.  14)- 

Second  and  terminal  phalanges  of  one  finger. — These  are  firmly  ankylosed 
in  a  flexed  position  (Plate  XXIV,  Fig.  15). 

The  diagnosis,  therefore,  is  that  of  spondylitis  deformans,  and, 
judging  from  the  one  metatarsal  bone  and  the  only  two  digital 
phalanges  left,  it  is  clear  that  other  joints  of  the  body  had  also 
suffered  severely. 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  99 

III.       SPONDYLITIS    DEFORMANS    IN    A    SKELETON    OF    THE     TWELFTH 
DYNASTY    (2OOO-1788   B.C.) 

Skeleton  of  a  woman  given  us  by  Sir  Gaston  Maspero.  The 
sarcophagus  in  which  the  body  was  contained  had  a  large  hole 
through  which  insects  had  entered  and  devoured  almost  everything 
save  the  skeleton.  The  only  exception  was  a  piece  of  organ  (a 
muscle  ?),  thickly  covered  with  the  pupae  of  insects,  a  piece  of  aorta 
(2 . 5  inches  in  length)  at  its  bifurcation,  and  small  pieces  of  ligament 
which  were  still  attached  to  the  spine.1 

Skull. — All  sutures  except  squamous  ossified.  Teeth  much  worn.  Alveoli 
of  left  first  premolar  and  all  three  molars,  right  second  and  third  molars  oblit- 
erated.   Left  canine  carious. 

Spinal  column. — First  four  cervical  vertebrae  normal;  fifth,  distinct  pro- 
jection of  new  bone  along  anterior  inferior  border  of  body;  sixth,  normal; 
seventh,  strong  projection  of  new  bone  on  left  anterior  inferior  border. 

Dorsal  vertebrae,  normal,  except  ninth  and  tenth. 

The  lower  border  of  the  ninth  dorsal  in  middle  line  and  corresponding 
part  of  the  upper  border  of  the  tenth  united  by  a  thick  osteophyte  about  1.5 
cm.  long  (Plate  XXV,  Fig.  17a),  the  base  of  which  is  almost  0.5  cm.  broad. 

Second  and  third  lumbar  vertebrae  show  some  overlipping. 

Spinous  processes  of  the  tenth,  eleventh,  twelfth  dorsal,  first  and  second 
lumbar  vertebrae  joined  together  by  a  strong  bridge  of  new  bone. 

The  other  bones  showed  no  naked-eye  lesions  whatever. 

The  case  is  interesting  because  the  disease  is  almost  localised 
in  front  to  the  bodies  of  the  ninth  and  tenth  dorsal  vertebrae,  and 
posteriorly  to  the  spinous  processes  of  a  few  vertebrae. 

1  With  regard  to  these  insects  and  similar  ones  found  in  this  and  Ptolemaic  mum- 
mies, Mr.  Ad.  Andres,  whose  knowledge  of  Egyptian  insects  is  unrivalled,  has  kindly 
given  us  the  following  note : 

"The  fragments  of  insects  which  I  have  just  received  and  which  were  found  by 
Dr.  M.  Armand  Ruffer  in  a  mummy  of  the  Ptolemaic  epoch  belong,  without  doubt,  to 
Coleoptera  of  the  Cleridae  family,  the  scientific  name  of  which  is  Necrobia  rufipes 
(GeerJ.  This  species  is  cosmopolitan  and  is  met  with  even  to-day  in  the  valley  of  the 
Nile  and  in  Upper  Egypt.  Hope  described  it  under  the  name  of  Necrobia  mnmiarum, 
but  there  can  be  no  doubt  that  it  belongs  to  the  species  mentioned  above.  (See 
Colcopterum  Catalogus,  par.  23,  S.  Schenkling,  p.  143;  et  Charles  Alluaud,  Ball.  Soc. 
Ent.  d'&gyple,  p.  31.)  This  is  also  the  case  with  the  Necrobia  glabra  (Champollion), 
which  is  identical  with  the  Necrobia  ntfipes  (Geer). 

•'In  a  communication  on  the  subject  made  in  October  last  before  the  Natural 
History  Society  of  Alexandria,  I  had  already  drawn  attention  to  this  beetle,  found 
together  with  a  very  large  quantity  of  fragments  of  pupae  of  Diptera  of  the  genus 
Lucilia  and  Sarcophaga  in  a  mummy  of  the  Xllth  Dynasty  by  Dr.  M.  Armand  Ruffer." 


ioo         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

IV.      DISEASE    OF   LEFT    SACROILIAC   ARTICULATION   AND   BOTH  HIP- 
JOINTS   LN   A  MUMMY   OF   THE   TWENTY-FIRST  DYNASTY 
(1090-945   B.C.) 

This  mummy  has  already  been  partly  described  by  Professor 
Elliot  Smith,  who  wrote  as  follows : 

In  the  case  of  an  extremely  emaciated  old  woman  called  Nesi-Tet-Nab- 
Taris,  a  curious  state  of  affairs  was  revealed.  Large  open  ante-mortem  wounds 
— possibly  bed-sores — were  found  on  the  back,  between  the  shoulders  and  on 
each  buttock.  These  had  been  made  use  of  for  the  purpose  of  packing  the 
back,  and  then  two  square  sheets  of  fine  leather  (  Pgazelle  skin)  had  been  applied 
to  cover  the  upper  wound  and  the  whole  buttock  respectively.  These  sheets 
had  been  sewn  to  the  healthy  skin  beyond  the  sores  and  the  edges  hidden  by 
straps  of  linen  which  were  smeared  with  a  resinous  paste.  A  large  opening — - 
probably  an  abscess  or  sinus — extended  transversely  from  the  left  pudendal 
labium  outward  into  the  buttock;  this  had  been  sewn  up  with  string. 

A  long  ulcer  on  the  back  of  the  leg  had  been  covered  up  by  a  sheet  of  linen 
soaked  in  a  solution  of  resin. 

Evidently  this  old  woman  had  been  long  bedridden.  Professor 
Elliot  Smith  obligingly  gave  us  the  pelvis  and  lower  limbs,  in  the 
hope  that  histological  investigation  might  throw  light  on  the  nature 
of  the  chronic  disease  she  had  suffered  from.  The  histological 
examination  threw  no  light  on  the  etiology  of  these  sinuses,  though 
we  discovered  that  the  peroneal  arteries  were  completely  ossified. 

The  remains  of  the  pelvis  and  lower  limbs  having  been  macer- 
ated, the  following  pathological  alterations  were  discovered : 

Right  femur. — Thick  deposit  of  new  bone  round  head  of  femur  (Plate  XXV, 
Figs.  18  and  19).  Surface  of  great  trochanter  very  rough,  owing  to  deposits  of 
whitish,  spongy-looking  bone,  specially  thick  at  upper  extremity  of  spiral  line. 
Depression  for  the  ligamentum  teres  irregular,  and  deeply  pitted  at  bottom. 

Left  femur  (Plate  XXV,  Figs.  20-21). — Neck  about  1  cm.  shorter  than 
that  of  right  femur,  owing  to  absorption,  and  this  process  having  taken  place 
more  rapidly  at  the  back,  the  neck  has  partly  collapsed  and  the  head  of  the 
bone  looks  almost  directly  backwards.  All  round  the  head,  especially  anteri- 
orly, new  bone  has  been  deposited.  Great  trochanter  roughened  by  deposit 
of  new,  whitish,  spongy  bone,  thicker  superiorly  and  anteriorly.  Fossa  for  the 
ligamentum  teres  deeply  pitted  and  much  enlarged. 

Pelvis. — Complete  ankylosis  between  sacrum  and  right  pelvic  bone  (Plate 
XXV,  Fig.  22).  In  right  acetabulum,  separation  between  articular  and  non- 
articular  parts  is  almost  worn  away  by  friction. 

On  the  left  side  no  trace  of  inflammation,  expect  on  the  ischial  tuberosity, 
which  is  rougher  than  usual.    In  the  acetabulum,  a  layer  of  new  bone  exists 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  101 

at  the  junction  of  the  articular  and  non-articular  parts.     The  latter  has  been 
so  much  worn  away  by  friction  that  it  is  of  transparent  thinness. 
The  bones  of  the  leg  were  normal. 

We  examined  no  complete  skeleton  of  the  XXIst  Dynasty,  but 
only  the  upper  and  lower  limbs  of  various  broken-up  mummies. 
Among  these  we  found  several  metatarsal  bones,  the  heads  of  which 
showed  evident  signs  of  osteo-arthritis.  Such  a  bone  is  photo- 
graphed in  Plate  XXV,  Fig.  23. 

One  radius  also  (Plate  XXVII,  Fig.  36)  showed  slight  signs  of 
osteo-arthritis. 

V.     SKELETON    OF    THE    TWENTY-SECOND    DYNASTY    (945-745   B.C.) 

This  and  the  skeleton  next  in  order  were  given  us  by  Professor 
Flinders  Petrie. 

VERTEBRAL    COLUMN 

Atlas. — Flat  projection  of  bone,  almost  1  cm.  long,  surrounding  nearly  half 
outer  border  of  right  condyle.  Small  projection  of  bone,  posterior  border  of 
left  condyle. 

Axis. — Normal,  except  that  the  left  extremity  of  the  bifid  spinous  process 
is  much  thickened,  longer  and  broader  than  on  the  other  side. 

Foramen  for  the  left  vertebral  artery  is  not  completely  closed. 

Fifth  cervical. — Distinct,  rough  new  bone  along  lower  posterior  border  of 
body  extending  laterally  as  far  as  the  foramina  for  vertebral  arteries. 

Sixth  cervical. — Some  new  bone  all  round  upper  and  lower  borders  of  body. 
Each  vertebral  foramen  is  divided  into  two  unequal  parts  by  very  thin  spiculum 
of  new  bone. 

Seventh  cervical. — New  bone  round  upper  border  of  body,  more  marked  on 
the  right  side.  Right  foramen  for  vertebral  artery  narrowed  by  osseous  growth 
to  one-fourth  of  the  left. 

First  dorsal. — Rough  new  bone  along  superior  anterior  border  extending 
for  about  0.3  cm.  down  the  body  of  the  vertebra.  Upper  left  costal  articula- 
tion very  rough  and  irregular,  especially  at  its  outer  border,  where  there  is  a 
slight  bony  projection. 

Tenth  dorsal. — Left  costal  articulation  is  very  rough  and  irregular. 

Eleventh  dorsal. — Both  costal  articulating  surfaces  very  rough,  with  new 
bone  round  them. 

First  lumbar. — Distinct  thinning  of  body  on  left  side. 

Second  lumbar. — Distinct  roughening  and  bony  formation  round  articulat- 
ing surfaces  on  two  upper  and  right  lower  articulating  processes. 

Third  lumbar. — New  bone  round  anterior  part  of  superior  border.  A  thin 
ridge  of  bone  extends  just  on  left  of  middle  line  along  anterior  part  to  a  thick 


102         STUDIES  IN  THE  PALAE0PATH0L0GY  OF  EGYPT 

osseous  excresence  which  almost  surrounds  the  lower  border.  This  is  especially 
marked  on  the  left  side.  Right  superior  articulating  surface  very  rough  and 
surrounded  by  osseous  growth. 

Fourth  lumbar. — Very  thick  layer  of  new  bone  round  anterior  border, 
especially  on  left  side  and  middle.  This  extends  for  some  distance  down  the 
body  of  the  vertebra  and  reaches  the  left  lower  border.  Much  new  bone  at 
base,  and  behind  left  superior  and  inferior  articulating  processes. 

Fifth  lumbar. — New  bone  right  round  superior  border  extending  down- 
wards along  body  for  i  cm.  nearly  (see  Plate  XXVI,  Fig.  26). 

Left  calcaneum. — The  antero-internal  facet  (Plate  XXVI,  Fig.  24)  is  divided 
into  two  secondary  facets  by  new  bone.  The  internal  tuberosity  sends  out  a 
spur  of  new  bone  for  1  cm.  This  is  very  irregular  and  is  really  formed  by 
three  small  tuberosities,  the  largest  of  these  being  in  front  and  below,  the 
second  somewhat  smaller  lies  in  front  and  above,  and  the  smallest  behind  and 
above. 

Fifth  metatarsal  bone. — Just  in  front  (Plate  XXVI,  Fig.  25)  of  the  articular 
facet  for  the  fourth  metatarsal  bone,  and  at  the  proximal  extremity  of  the 
internal  surface,  there  is  a  large  osseous  tuberosity  looking  upwards  and  back- 
wards. Another  similar  tubercle  on  the  superior  aspect  and  external  margin, 
about  1  cm.  from  the  anterior  articulation,  but  separated  from  this  by  a  deep 
groove. 

Sacrum. — Small  exostoses  on  right  superior  border. 

First  right  metacarpal  bone. — Small  multiple  exostoses  on  phalangeal 
articulation. 

Femurs. — The  fossae  for  the  ligamentum  rotundum  are  irregular  owing  to 
the  presence  of  numerous  small  exostoses. 

VI.    SKELETON  DATING  FROM  THE  PERSIAN   OCCUPATION   OF   EGYPT 
(ABOUT    500   B.C.) 

VERTEBRAL   COLUMN 

All  vertebrae  present,  except  axis  and  the  seventh  cervical  vertebra,  which 
could  not  be  found. 

Atlas. — Cavity  for  odontoid  process  surrounded  above  and  laterally  by  a 
strong  layer  of  rough  new  bone.  From  the  shape  of  the  cavity  it  is  evident  that 
the  odontoid  process,  instead  of  looking  upwards,  was  bent  slightly  backwards. 
Right  tubercle  for  attachment  of  transverse  ligament  slightly  roughened,  and 
so  is  bone  just  below  right  condylar  process.  Foramen  in  the  right  transverse 
process  not  entirely  closed. 

Third  cervical. — Upper  and  lower  surfaces  deeply  hollowed,  especially  on 
upper  surface,  where  hollow  is  nearly  1  cm.  in  depth.  Upper  surface  very 
rough.  Some  formation  of  new  bone  along  anterior  lower  border,  new  bone 
being  about  0.2  cm.  thick.    Whole  body  of  vertebra  very  thin,  measuring  just 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  103 

0.5  cm.  in  thickness.  On  side  of  lower  surface  there  has  been  a  good  deal  of 
absorption  of  the  bone. 

Fourth  cervical. — This  shows  same  lesions,  but  projection  of  new  bone 
along  anterior  inferior  border  is  more  marked  and  irregular.  Distinct  atrophy 
of  body,  less  than  0.5  cm.  thick. 

Fifth  cervical. — Marked  hollowing  out  of  upper  surface  of  body.  Distinct 
formation  of  new  bone  along  upper  anterior,  and  slightly  also  along  upper 
posterior  border.  Lower  surface  practically  normal.  Thickness  of  vertebra, 
0.6  cm. 

Sixth  cervical. — No  new  bone;  body  about  1.2  cm.  thick. 

Seventh  cervical. — Missing. 

Sixth  dorsal. — Left  lower  articulating  facet  very  irregular  in  shape,  rough, 
and  nearly  double  the  size  of  its  fellow  on  account  of  formation  of  new  bone 
round  it. 

Seventh  dorsal. — Right  lower  articulating  facet  very  irregular  in  shape 
and  double  the  size  of  its  fellow.  The  same  is  the  case  with  right  anterior 
articular  facet.  Bodies  of  both  these  vertebrae  slightly  thinner  on  the  right 
side. 

Eighth  dorsal. — Left  lower  articular  facet  greatly  enlarged,  very  irregular, 
with  some  thick  new  bone  around  it.  Superior  border  of  the  body  somewhat 
rough.  Lower  border  of  the  body  rough,  with  a  projection  of  new  bone  0.3 
cm.  thick  and  about  1  cm.  long  on  right  side  (Plate  XXVI,  Fig.  27).  Both 
upper  articular  facets  very  irregular  and  rough,  owing  to  new  bone,  especially 
on  left  side.    Right  side  of  body  distinctly  atrophied. 

Ninth  dorsal. — Lower  articulating  surface  very  rough  and  irregular,  espe- 
cially on  the  left  side.  Upper  articulating  processes  fairly  smooth,  but  very 
irregular  in  shape.  Upper  surface  of  body  shows  large  projection  of  new  bone 
2.5  cm.  long  and  1  cm.  broad,  fitting  the  similar  projection  on  vertebra  above 
<  Plate  XXVI,  Fig.  27).  There  is  distinct  atrophy  of  right  side  of  body  of  ver- 
tebra. Lower  surface  of  body  shows  bony  projection  similar  to  that  above, 
the  two  being  joined  by  a  strong  pillar  of  new  bone.  The  upper  facet  for 
the  left  rib  side  is  enlarged,  rough,  surrounded  by  new  bone,  and  almost  unrecog- 
nisable. 

Tenth  dorsal. — On  right  upper  border,  a  strong  excrescence  of  new  bone 
fitting  in  with  the  one  above  (Plate  XXVI,  Figs.  27,  28,  and  29).  Upper 
articular  processes  irregular,  but  otherwise  almost  normal.  Distinct  atrophy 
of  right  side  of  body.  Some  slight  formation  of  new  bone  along  right  lower 
border  of  body. 

Eleventh  and  twelfth  dorsals. — Practically  normal. 

First  lumbar. — Normal,  except  for  some  thickening  round  left  posterior 
articular  surface. 

Fourth  and  fifth  lumbars. — Some  thickening  around  upper  border  of 
body. 


104         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

N.B. — This  skeleton  belonged  to  a  man  less  than  twenty-five 
years  of  age,  as  the  wisdom  teeth  had  not  yet  cut  through. 

Bouchard's  nodosities. — The  hands  of  one  mummy  of  the  time 
of  the  Persian  occupation  showed  enlargement  of  the  heads  of  the 
first  phalanges  (Plate  XXVI,  Figs.  30  and  31);  a  malformation  to 
which  special  attention  has  been  drawn  by  Ch.  Bouchard,  and 
which  this  observer  has  shown  to  be  caused  by  chronic  dilatation 
of  the  stomach. 

VII.  SPONDYLITIS  DEFORMANS  AND  OTHER  ARTHRITIC  LESIONS  IN 

BODIES  FROM  THE  TOMBS  OF  THE  SOLDIERS  OF  ALEXANDER 

THE  GREAT  AND  PTOLEMY  I,  AT  CHATBY  (ABOUT  300  B.C.) 

This  disease  was  very  common  among  the  people  buried  at 
Chatby.  Accurate  statistics  as  to  the  frequency  of  the  disease, 
cannot  be  given,  because,  as  has  been  mentioned  before,  the  exact 
number  of  people  in  the  graves  examined  can  only  be  guessed  at. 
Altogether,  thirty-two  skulls  were  found,  but  it  is  quite  possible 
that  the  fragments  found  belonged  to  many  more  bodies,  as  the 
number  of  skulls  does  not  agree  with  the  number  of  inferior  maxillae 
nor  with  that  of  the  right  femurs.  Judging  from  the  number  of  the 
latter,  it  is  certain  that  at  least  forty  adults  or  fragments  of  adult 
bodies  were  interred  at  Chatby  in  the  graves  we  examined. 

In  only  one  grave  did  we  find  a  skeleton  in  which  no  bones  were 
missing.  The  body  was  that  of  a  young  woman  whose  third  molars 
had  not  quite  emerged.  It  was  in  a  very  bad  state  of  preservation, 
the  skull  and  smaller  bones  crumbling  to  bits  when  an  attempt  was 
made  to  remove  them.  Nevertheless,  it  was  ascertained  that  the 
whole  spinal  column  from  end  to  end  showed  the  early  lesions  of 
spondylitis  deformans,  namely,  overlipping  of  the  superior  and 
inferior  borders  of  the  bodies  of  the  vertebrae  together  with  en- 
largement, eburnation,  and  ankylosis  of  the  articulating  surfaces. 
The  odontoid  process  of  the  axis  was  capped  by  a  layer  of  thick 
new  bone. 

The  other  bones  of  the  body  showed  slight  alterations  only. 
In  the  lower  limbs  the  tuberosities  of  the  femurs  were  very  rough, 
there  was  much  thickening  along  the  linea  aspera  of  the  shaft  of  the 
femur  and  the  insertions  of  both  quadriceps  extensor  femoris  in 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  105 

the  patellae  were  ossified.  In  the  upper  limbs,  the  only  alteration 
observed  was  some  thickening  and  pitting  round  the  outer  border 
and  tuberosities  of  the  olecranon.  The  bones  of  the  hands  and  feet 
which  could  be  found  showed  no  special  alterations. 

In  several  other  graves  vertebrae  were  found  ankylosed,  or  else 
in  such  a  position  that  it  was  clear  that  they  belonged  to  the  same 
body.     Typical  examples  of  the  lesions  found  may  now  be  given. 

CERVICAL  REGION 

No.  1. — Ankylosis  of  axis  and  third  cervical  articular  surfaces  joined  by 
strong  new  bone,  extending  backwards  on  right  side  almost  to  spinous  process. 
Posterior  borders  of  bodies  firmly  ankylosed  by  new  bone  which  has  evidently 
developed  in  the  posterior  ligaments.  Odontoid  process  very  rough,  especially 
at  lower  borders  of  groove  for  transverse  ligament.  Tip  of  process  rough, 
irregular,  and  capped  with  newly  formed  bone.  Inferior  articular  process  of 
third  vertebra  greatly  enlarged  and  surrounded  by  osseous, outgrowth.  Long 
spur  projects  from  inferior  anterior  border  of  third  vertebra. 

No.  2. — Ankylosis  of  third,  fourth,  and  fifth  cervical  vertebrae.  The  upper 
and  lower  borders  of  the  bodies,  especially  those  of  the  sixth,  are  rather  thick- 
ened; otherwise  the  bodies  are  practically  normal.  The  disease  is  chiefly 
confined  to  the  articular  surfaces,  which,  with  two  exceptions,  are  enormously 
thickened,  flattened,  and  bound  together  by  thick  new  bone. 

The  atlas  vertebra  often  shows  osseous  overgrowth  on  the  upper 
lateral  borders  of  the  notch  for  the  odontoid  process,  together  with 
thickening  and  roughening  of  the  tubercles  for  the  attachment  of 
the  transverse  ligament.  As  a  rule,  however,  the  articulating 
surfaces  are  healthy. 

In  the  axis  vertebra,  the  disease  chiefly  affects  the  inferior 
articulating  surfaces  which  are  flattened,  irregular  in  shape,  ebur- 
nated,  at  the  same  time  worm-eaten  and  considerably  enlarged, 
sometimes  measuring  as  much  as  2.5  cm.  in  their  widest  part. 
In  such  cases,  the  whole  articulating  surface  is  surrounded  with 
strong  new  bone. 

The  anterior  surface  of  the  odontoid  is  sometimes  eburnated, 
and  a  prolongation  of  eburnated  bone  may  extend  for  2  or  3  mm. 
above  the  tip  of  the  process  and  for  a  similar  distance  laterally. 
This  condition  must  have  caused  considerable  limitation  of 
movement  during  life. 


106         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Similar  lesions  occur  frequently  in  the  cervical  vertebrae  (Plate 
XXVII,  Fig.  37),  and  are  not  seldom  limited  to  the  articular  sur- 
faces. The  spinous  processes  always  escape  apparently.  In  one 
vertebra,  the  lower  border  was  greatly  enlarged  owing  to  a  V-shaped 
prolongation  of  new  bone.  Whereas  the  upper  and  lower  surfaces 
of  the  bodies  of  the  dorsal  vertebrae  are  almost  always  normal,  the 
same  surfaces  in  the  cervical  vertebrae  are  often  very  rough  and 
deeply  pitted.  The  anterior  part  of  the  body  is  frequently  greatly 
worn  away,  so  that  the  vertebrae  of  the  neck  must  have  fallen 
together  to  some  extent  in  front,  with  extensive  deformation  of  the 
neck  as  the  result. 

In  one  specimen  the  skull  and  the  three  first  cervical  verte- 
brae (Plate  XXVII,  Fig.  40)  were  firmly  ankylosed  together  as  the 
result  of  osteo-arthritis,  and  the  deformity  during  life  was  doubtless 
very  great.  The  spinal  canal  formed  an  obtuse  angle  with  the 
foramen  magnum,  so  that  the  man's  chin  almost  touched  his  chest. 

DORSAL  REGION 

The  dorsal  vertebrae  show  changes  very  similar  to  those  found 
in  the  cervical  vertebrae.  Very  often  three  or  more  vertebrae  are 
firmly  ankylosed  (Plate  XXVII,  Fig.  34) .  The  following  may  serve 
as  a  typical  example: 

Bony  mass  consisting  of  three  dorsal  vertebrae.  In  first  vertebra  upper 
border  of  body  considerably  thickened,  especially  anteriorly  where  new  bone 
measures  at  least  0.5  cm.  Lower  border  on  right  of  middle  line  throws  out 
a  flat  osteophyte  measuring  1  by  2  cm.  This  exactly  fits  with  a  similar  osteo- 
phyte growing  from  the  vertebra  below.  Upper  and  lower  articulating  surfaces 
very  rough,  irregular,  and  enlarged.  Next  vertebra  shows  changes  similar 
to  the  one  above.  The  top  of  the  transverse  process  is  rough  and  thickened. 
The  costal  articulating  surfaces  are  very  rough.  Anterior  border  of  last 
vertebra  very  rough,  throws  out  a  strong  osteophyte  fitting  with  similar 
projection  from  bone  above.  Lower  border  of  body  somewhat  thickened. 
Superior  articulating  surfaces  very  rough,  irregular,  enlarged,  and  partly  sur- 
rounded by  new  bone,  especially  thick,  on  right  inferior  border.  Lower 
articulating  surfaces  somewhat  rough,  enlarged,  and  irregular,  though  altera- 
tions less  marked  than  in  vertebra  above.  Tip  of  left  transverse  process 
enlarged,  rough,  and  costal  articulating  surfaces  almost  worn  away. 

Such  ankylosed  masses  are  of  common  occurrence,  and  the  large 
majority  of  the  dorsal  vertebrae  found  showed  inflammatory 
changes  more  or  less  profound. 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  107 

The  early  stages  of  the  disease  usually  show  themselves  in  the 
dorsal  and  lumbar  regions  (Plate  XXVII,  Fig.  33)  on  the  anterior 
borders  of  the  body  on  either  side  close  to  the  middle  line.  They 
are  characterised  by  the  formation  of  a  small  lip  which  meets  a 
similar  prolongation  projecting  from  the  vertebra  above  or  below". 
Occasionally  this  overgrowth  measures  as  much  as  2  or  3  cm.  in 
length,  the  body  of  the  vertebra  remaining  normal.  Sometimes  the 
new  bone  spreads  as  a  thick  ridge  all  round  the  anterior  border  of 
the  body  and  forms  powerful  masses  which  may  extend  over  the 
side  of  the  vertebra;  these,  meeting  with  similar  ridges  on  the  verte- 
bra above  or  below,  all  three  vertebrae  become  firmly  ankylosed. 
The  anterior  and  lateral  spinal  ligaments  in  such  cases  are  firmly 
ossified,  though  recognisable. 

The  disease  seldom  extends  to  the  posterior  spinal  ligament,  and 
even  should  the  latter  become  completely  ossified,  the  new  bone 
never  intrudes  on  the  canal. 

The  intervertebral  cartilages  were  apparently  quite  normal,  as 
there  are  no  signs  of  inflammation  on  the  surfaces  of  the  body. 
Not  infrequently  the  disease  extended  to  the  transverse  processes, 
and  especially  to  the  articulating  surfaces,  which  are  then  firmly 
tied  together  by  new  bone,  sometimes  as  much  as  5  mm.  thick. 
The  articulating  surfaces  may  measure  as  much  as  2  . 5  by  1 . 5  cm., 
and  are  then  frequently  eburnated  and  look  worm-eaten. 

The  costal  articulating  surfaces  usually  escape.  Occasionally 
they  are  rough,  uneven,  with  signs  of  inflammation  round  them. 

The  spinal  processes  are  normal,  with  the  exception  of  a  few 
cases  where  small  osteophytes  are  present. 

As  a  rule,  the  bodies  of  the  vertebrae  are  not  atrophied  at  all. 
The  deformation  of  the  spine  during  life  cannot  have  been  very 
marked  therefore,  even  when  there  must  have  been  considerable 
limitation  of  movement. 

LUMBAR  REGION  AND  PELVIS 

The  lumbar  vertebrae  show  changes  identical  with  those  seen 
in  the  dorsal  region.    One  example  will  suffice : 

This  specimen  consists  of  two  lumbar  vertebrae  (Plate  XXVII,  Fig.  32) 
which  are  firmly  bound  together  by  a  strong  mass  of  new  bone  extending  almost 


108         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

right  round  the  adjoining  bodies  of  both  vertebrae.     The  strong  prolongations 
show  that  the  disease  extended  to  the  vertebrae  both  above  and  below. 

The  changes  in  the  spinous  process  are  often  very  marked,  and 
vary  from  simple  irregularity  and  roughness  to  complete  ankylosis, 
so  that  all  the  spinous  processes  are  joined  together  by  strong  bone. 

The  number  of  lumbar  vertebrae  showing  marked  changes  is 
enormous.  Indeed,  the  majority  of  lumbar  vertebrae  which 
were  found  exhibited  lesions,  more  or  less  severe,  of  spondylitis 
deformans. 

Osteo-arthritic  changes  in  sacrum  and  coccyx. — The  sacrum  was 
firmly  ankylosed  with  the  right  ilium  in  two  cases  (Plate  XXX, 
Fig.  49)  and  with  the  fifth  lumbar  vertebra  in  two  other  specimens 
(Plate  XXX,  Fig.  52).  In  two  others  the  ankylosis  between  the 
fifth  lumbar  and  the  sacrum  was  not  complete.  In  another  (Plate 
XXX,  Fig.  53)  a  strong  osteophyte  extended  upwards  from  the 
left  anterior  superior  border  of  the  sacrum  to  the  fifth  lumbar 
vertebra. 

The  coccyx  was  never  found  diseased. 

On  the  whole,  therefore,  the  sacrum  and  coccyx  often  escaped. 

Osteo-arthritic  and  other  changes  in  the  pelvis. — One  pelvis  is  not 
only  firmly  ankylosed  to  the  sacrum,  but  shows  other  points  of 
interest. 

The  ankylosis  is  complete  anteriorly  as  far  as  the  lower  border  of  the  first 
sacral  vertebra,  posteriorly  the  bones  are  united  by  two  strong  bridges  of 
osseous  tissue  separated  by  an  interval.  The  whole  length  of  the  ischial 
ramus  on  its  external  surface,  and  especially  near  the  inferior  border,  is  covered 
with  thick,  rough  new  bone,  which  though  becoming  less  is  still  very  prominent 
near  the  ramus  of  the  pubes.  The  inner  and  outer  borders  of  the  obturator 
foramen  are  very  rough  owing  to  stalactite-like  outgrowths  of  inflammatory 
osseous  tissue.  The  superior  ramus  of  the  pubes  and  ilio-pectineal  eminence 
are  covered  with  small  osseous  excrescences  on  their  external  surface. 

The  left  (Plate  XXX,  Fig.  48)  side  of  the  pelvis  shows  the  same  lesions 
as  the  right,  and  the  stalactite  formations  round  the  obturator  foramen  are 
even  more  marked. 

In  the  right  acetabulum,  the  non-articular  portion  remains  normal,  whereas 
a  strong  ridge  of  new  bone  lines  the  upper  border  of  the  articular  portions, 
especially  on  the  outer  side.  Much  evidence  of  inflammation  on  right  ischial 
tuberosity,  especially  on  its  external  and  inferior  border.  The  left  acetabular 
cavity  is  much  worn,  though  there  are  no  signs  of  inflammation. 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  109 

Pathological  changes  in  the  acetabula  are  fairly  common.  In 
some,  friction  has  completely  worn  away  the  separation  between 
the  articular  and  non-articular  portions.  In  others,  some  deposit 
of  new  bone  had  taken  place  at  the  upper  margin  of  the  non- 
articular  portion  of  the  acetabulum. 


In  contrast  to  the  spine,  the  femurs  showed,  as  a  rule,  but  slight 
lesions,  and  even  these  did  not  occur  often.  Altogether  only  nine 
femurs  showed  any  lesions,  the  most  pronounced  of  which,  at  the 
upper  end,  were  as  follows: 

No.  1. — On  upper  surface,  at  junction  of  head  with  neck,  there  is  a  deposit 
of  thick  new  bone,  which,  narrowing  gradually,  extends  almost  round  the 
head.  Insertion  of  ligamentum  teres  surrounded  by  thick  new  bone  measures 
2  by  1.5  cm.,  and  the  floor  is  rough.  Numerous  small  spiculae  of  bone  behind 
greater  tuberosity,  as  if  tendons  of  muscles  inserted  there  were  partially  ossified. 
Some  formation  of  new  bone  just  below  the  small  tuberosity. 

The  following  is  a  description  of  the  most  conspicuous  example 
of  disease  at  the  lower  extremity  of  the  bone: 

No.  2. — Lower  extremity  of  right  femur. — Great  thickening  round  external 
and  internal  borders  of  both  condyles,  especially  marked  behind  inner  condyle, 
where  new  bone  forms  a  thick  ridge  separated  from  the  bone  beneath  by  a 
space  of  about  2  mm.  Conspicuous  eburnation  of  inner  condyle.  Just  above 
the  eburnated  part  there  is  a  small  raised  nodule  of  rough  new  bone,  about 
the  size  of  a  threepenny  piece. 

In  the  other  cases,  the  lesions  were  very  slight,  consisting  only  of 
some  small  deposit  of  bone  round  the  head,  some  roughening  of  the 
great  trochanter  or  of  the  intertrochanteric  line.  At  the  lower 
extremity  of  the  femur  the  changes  consisted  only  of  some  slight 
thickening  round  the  borders  of  the  condyles. 

A  peculiar  deformity  of  the  femur  is  shown  in  Plate  XXVIII, 
Figs.  41,  42,  and  43. 

Here  the  great  trochanter  and  the  intertrochanteric  line  are  capped  by  an 
enormous  growth  of  spongy  bone  measuring  about  5  cm.  in  thickness,  which  is 
reflected  in  a  thick  layer  round  the  junction  of  the  neck  of  the  bone  with  the 
shaft.  The  neck  of  the  bone  itself  is  practically  normal.  This  enormous 
it*,-:,  ih  consists  of  loose,  spongy  bone,  which  microscopically  shows  nothing 
peculiar.  Anteriorly,  this  growth  ends  at  the  lower  end  of  the  linea  aspera, 
which  is  considerably  broadened  and  flattened. 


no         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  head  of  the  bone  shows  some,  but  not  very  marked,  thickening  at  its 
posterior  border.  The  cup  for  the  cotyloid  ligament  had  been  considerably 
damaged,  and  exhibits  no  special  sign  of  disease.  The  lower  extremity  of  the 
femur  presents  some  slight  signs  of  osteo-arthritis  round  the  borders.  The 
shaft  of  the  femur  is  nowhere  enlarged. 

The  diagnosis  in  this  case  must  remain  doubtful.  We  thought 
at  first  that  we  were  in  presence  of  a  specimen  of  osteoma  or  osteo- 
sarcoma. Against  this  diagnosis  we  may  point  to  the  fact  that  the 
shaft  of  the  femur  itself  appears  to  be  quite  normal,  and  the  surface 
of  the  tumour,  except  over  the  great  trochanter,  is  everywhere  quite 
smooth.  The  interior  of  the  growth  is  composed  of  normal  loose 
osseous  tissue. 

Considering  that  this  person  had  slight  osteo-arthritic  lesions  of 
the  lower  extremity  and  of  the  head  of  the  bone,  it  may  be  argued 
that  the  more  striking  lesions  were  also  of  the  same  nature.  Assum- 
ing this  to  be  possible,  it  is  not  a  little  strange  that  the  lesions 
should  be  almost  entirely  limited  to  the  posterior  region  round  the 
trochanters. 

Unfortunately,  the  other  bones  belonging  to  this  skeleton  could 
not  be  discovered,  this  femur  lying  loose  in  the  ossarium  before 
mentioned. 

Another  interesting  femur  found  in  the  same  ossarium  is  the  one 
shown  in  Plate  XXIX,  Fig.  44.  Here  the  head  of  the  femur  had 
been  almost  completely  worn  away,  though  signs  of  inflammation 
could  still  be  seen  along  its  upper  and  outer  border.  The  great 
trochanter  had  been  badly  smashed.  In  this  instance,  we  do  not 
think  the  possibility  of  the  lesions  having  been  tubercular  can  be 
excluded. 

TIBIA 

The  tibia  is  normal,  as  a  rule,  and  in  only  one  were  severe  lesions 
noticed.  This  is  a  left  tibia  in  which  there  is  marked  eburnation 
of  the  upper  articulating  surface  posteriorly. 


This  bone  shows  no  changes,  as  a  rule.  In  several  cases,  how- 
ever, the  upper  surface  is  very  rough,  and  upper  border  throws  out 
a  fiat  excrescence  of  bone  formed  in  the  tendon  of  the  quadriceps 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  in 

extensor  femoris.     There  must  have  been,  therefore,  considerable 
limitation  in  movement. 

CALCANEUM 

Marked  osteo-arthritic  lesions  of  the  calcaneum  were  never 
found.  On  the  other  hand,  the  tendon  of  the  gastrocnemius  muscle 
was  ossified  in  two  cases  for  a  distance  of  2-2 . 5  inches  at  its  insertion 
into  the  calcaneum.  The  insertion  of  the  plantar  fascia  in  the 
calcaneum  also  was  converted  into  a  spur  of  bone  3-5  cm.  in  length, 
in  four  subjects  (Plate  XXVII,  Fig.  38). 

BONES   OF  THE  FOOT1 

The  following  were  the  lesions  noted : 

1.  First  metatarsal. — Right  shows  well-marked  osteo-arthritic  lesions  of 
head. 

2.  First  metatarsal. — Left  about  one-third  of  internal  part  of  head  with  a 
portion  of  internal  half  of  shaft  broken  off.  Osteo-arthritis  distinct  in  remain- 
ing portion  of  head. 

3.  First  phalanx  of  great  toe. — Right,  slight  lesions  of  head. 

4.  First  phalanx  of  great  toe. — Left,  slight  lesions  of  head. 

5.  Fifth  metatarsal. — Right,  slight  lesions  of  head. 

6.  Fifth  metatarsal. — Left,  slight  lesions  of  head. 

7.  Fifth  metatarsal. — Right,  slight  lesions  of  head. 

8.  Fifth  metatarsal. — Right,  slight  lesions  of  head. 

9.  Third  metatarsal. — Right,  slight  lesions  of  head. 
10.  Second  metatarsal. — Right,  slight  lesions  of  head, 
n.  Second  metatarsal. — Right,  slight  lesions  of  head. 

12.  A  metatarsal  bone. — Proximal  end  so  much  modified  by  disease  that 
it  is  not  possible  to  be  certain  whether  it  is  the  second,  third,  or  fourth. 

13.  D.D.  phalanx  of  first  row,  second  toe. — Slight  lesions  of  head. 

BONES  AND  ARTICULATIONS   OF  THE   UPPER  EXTREMITY 

Like  the  lower,  the  upper  extremities  were  but  seldom  the  seat 
of  disease. 

The  scapulo-humeral  articulations  are  always  normal,  as  also 
the  head  of  the  humerus  generally.  In  eight  cases  there  is  some 
slight  deposit  of  new  bone  round  the  anatomical  neck,  and  three 
times  on  the  large  and  small  tuberosities  also. 

1  We  are  greatly  obliged  to  Dr.  Wahby,  professor  of  anatomy  at  the  Cairo  Medical 
School,  for  much  help  in  the  examination  of  some  of  these  bones,  as  also  the  bones  of 
the  hand. 


112         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

A  curious  change  was  noted  in  one  left  humerus  in  which,  at  the 
junction  of  the  head  and  the  upper  tuberosity,  there  is  a  depression 
about  i  cm.  deep,  i  cm.  broad,  and  4  cm.  long,  with  somewhat 
irregular  borders,  and  perfectly  smooth  walls.  The  inferior 
posterior  part  of  the  head  is  somewhat  worn  away. 

In  only  two  cases  did  the  inferior  extremity  of  the  humerus  show 
any  signs  of  disease.  In  the  first,  eburnation  of  the  capitellum  is 
a  conspicuous  feature,  and  there  is  also  some  roughening  and 
formation  of  new  bone  in  the  olecranon  fossa. 

In  another  case,  the  ridge  between  the  capitellum  and  internal 
condyle  is  almost  completely  worn  away. 

BONES  OF  THE  FOREARM  AND  CARPUS 

These  were  remarkably  healthy,  no  lesions  whatever  being 
found.     Only  three  metacarpal  bones  were  found  diseased: 

1.  First  metacarpal  bone. — Right,  the  digital  extremity  is  modified  in  a 
typical  manner  by  osteo-arthritis.  The  bone  is  thick  and  long,  and  must  have 
belonged  to  a  very  big  hand. 

2.  First  metacarpal  bone. — Right,  slight  lesions  of  osteo-arthritis. 

3.  First  metacarpal  bone. — Left,  slight  lesions  of  osteo-arthritis. 

Fractures. — Lastly,  among  the  pathological  specimens  may  be 
included  two  fractures  of  the  bones  of  the  lower  limbs. 

The  first  (Plate  XXIX,  Fig.  45)  is  a  consolidated  fracture  of  the 
femur  of  one  of  the  soldiers  of  Alexander  the  Great.  The  bone 
had  been  very  badly  set,  and  the  result  was  deplorable  from  every 
point  of  view. 

The  second  (Plate  XXIX,  Figs.  46  and  47)  is  a  fracture  of  the 
tibia  and  fibula  found  in  a  mummy  dating  from  the  time  of  the 
Persian  occupation  (about  500  B.C.).  Here  the  result  was  much 
better,  as  the  tibia  shows  only  o.  5  cm.,  shortening  when  compared 
with  its  fellow. 

These  are  the  only  examples  of  injury  that  we  found. 

Exostosis. — One  Greek  rib  (Plate  XXXI,  Fig.  55)  had  a  curious 
rounded  exostosis  about  2  cm.  long,  tapering  to  a  blunt,  round 
extremity.  This  was  unfortunately  broken  by  a  somewhat  too 
muscular  visitor.  The  exostosis  was  composed  of  dense  cancellous 
tissue,  as  is  well  shown  in  the  photograph. 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  113 

EXAMINATION   OF  DECALCIFIED  BONES 

In  order  to  study  the  histological  changes  present  in  spondylitis 
deformans,  some  vertebrae  and  other  bones  presenting  the  typical 
lesions  of  the  disease  were  decalcified  in  alcohol  containing  3  per 
cent  of  nitric  acid.  After  complete  decalcification  this  fluid  was 
replaced  by  strong  spirit,  which  was  changed  on  three  consecutive 
days  or  oftener.  The  bone  can  then  be  easily  cut  through  with 
a  knife  or  a  strong  razor. 

By  this  method  it  was  ascertained  that  in  the  vertebrae  and  in 
the  other  bones  the  lesions  never  extend  to  the  interior  of  the  bones, 
and  were  entirely  superficial.  The  interior  of  the  bone,  vertebra, 
or  femur  is  to  the  naked  eye  absolutely  normal.  In  the  vertebrae 
this  condition  is  specially  evident,  for  in  no  case  except  in  the  cervi- 
cal region  did  the  surfaces  in  contact  with  the  intervertebral  discs 
show  any  changes  whatever  to  the  naked  eye.  The  only  exception 
is  that  the  surface  of  the  body  of  the  vertebra  near  the  anterior 
border  appeared  to  decalcify  more  slowly,  and  to  be  of  somewhat 
tougher  consistence  than  normal. 

Where  eburnation  has  taken  place,  as,  for  instance,  in  the 
articulating  surfaces  of  the  cervical  vertebrae,  the  change  is  entirely 
superficial,  probably  as  a  result  of  friction,  as  the  bone  immediately 
underneath  the  eburnated  surface  presents  no  pathological  lesions. 

Similarly,  in  sections  through  the  thickenings  round  the  head  of 
the  femur  or  round  the  lower  condyles  of  the  tibia,  the  lesions  did 
not  affect  the  bone  at  all,  and  were  limited  to  the  periosteum  and 
neighbouring  tissues. 

The  evident  eburnation  proved  that  the  cartilages  had  atrophied 
and  disappeared,  but  in  no  case  did  we  find  any  signs  which  would 
lead  us  to  believe  that  ossification  had  taken  place  in  the  cartilages. 
Even  in  the  one  case  of  complete  ankylosis  of  the  second  and  third 
phalanx  of  one  finger,  the  cartilage  had  disappeared  without 
leaving  a  trace. 

ROMAN  PERIOD     (ABOUT  200  A.D.) 

We  have  cleared  only  two  tombs  of  that  period,  containing  eight 
adult  bodies.  Of  these  eight  skeletons  no  less  than  four  showed 
marked    lesions   of   arthritis   deformans.     One   skeleton,    indeed, 


114         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

resembled  to  a  remarkable  extent  that  of  the  Illrd  Dynasty,  which 
has  been  described  already,  for  the  whole  of  the  vertebral  columns 
had  been  converted  into  a  rigid  block  of  bone.  Two  sections  of  the 
column  are  shown  in  Plate  XXXI,  where  Fig.  60  represents 
the  lower  cervical,  and  Fig.  61  the  lumbar,  region.  In  the  latter  the 
disease  had  spread  to  the  spinous  processes,  which  were  firmly  held 
together  by  the  osseous  overgrowth.  Plate  XXXI,  Fig.  58,  is  a 
photograph  of  two  dorsal  vertebrae  of  the  same  column  in  which 
the  pathological  changes  are  obvious. 

The  femurs  also  show  obvious  signs  of  disease.  At  the  junction 
of  the  head  and  neck  (Plate  XXXI,  Fig.  54)  a  thick  layer  of  new 
bone  almost  surrounds  the  whole.  The  great  trochanter  is  much 
roughened  owing  to  new  deposit,  and  small  osteophytes  protrude 
for  some  distance.  The  articulating  surfaces  of  the  knee-joint, 
especially  laterally,  are  also  greatly  thickened  from  the  same  cause. 
The  left  ulna  is  diseased  also,  as  the  borders  of  the  greater  and  lesser 
sigmoid  cavity  and  the  olecranon  are  very  rough  and  show  consider- 
able osseous  hypertrophy. 

One  of  the  metatarsal  bones  (Plate  XXXI,  Fig.  59)  also  presents 
the  typical  deformities  of  arthritis  deformans. 

The  innominate  bones  are  peculiar.  The  rami  of  the  ischium 
and  pubes,  together  with  the  tuberosity  of  the  ischium,  are  very 
rough.  Between  the  inferior  curved  line  and  the  upper  border  of 
the  acetabulum  (Plate  XXX,  Fig.  51)  the  bone  is  extremely  rough 
and  covered  with  minute  rounded  elevations  of  new  bone,  which 
greatly  resemble  those  already  described  in  Plate  XXX,  Fig.  48. 
The  sacrum  was  normal. 

Three  other  skeletons  showed  typical  deformities  due  to  spon- 
dylitis deformans,  and  in  them  the  disease  appeared  to  be  strictly 
limited  to  the  spine.  The  lesions  of  the  vertebrae  were  abso- 
lutely characteristic,  and  in  one  case  the  lumbar  vertebra  was 
firmly  ankylosed  with  the  sacrum. 

OSSEOUS  LESIONS  IN  COPTIC  BODIES 

Coptic  body  given  us  by  Professor  Breccia,  and  dating  from  the 
fifth  century  a.d.  It  had  been  enclosed  in  a  coffin  which  had  been 
buried  in  sand,  and  had  never  been  artificially  mummified. 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  115 

The  external  surfaces  of  the  ramus  of  the  pubes  and  part  of  the 
body  were  covered  with  a  layer  of  new  bone.  The  new  bone  was 
fairly  smooth,  though  with  a  worm-eaten  appearance  in  places.  It 
measured  4  by  4.5  cm.,  and  was  in  places  about  0.75  cm.  thick. 
Superiorly  the  new  bone  was  sharply  limited  by  a  ridge  and  a  deep 
groove  (Plate  XXX,  Fig.  50).  There  was  some  evidence  of  perios- 
titis along  the  lower  border  of  the  ramus  of  the  pubes  as  far  as  the 
junction  with  the  ramus  of  the  ischium. 

The  internal  surface  of  the  bone  was  quite  healthy. 

The  articulating  surfaces  of  the  symphysis  pubis  were  smooth. 
On  the  internal  surface  on  each  side  of  the  joint  there  was  a  layer 
of  new  spongy  bone  o .  5  cm.  broad  and  about  2 . 5  mm.  thick  on  the 
right,  and  a  layer  quite  1  mm.  thick  on  the  left  side.  Otherwise  the 
left  innominate  bone  was  quite  healthy. 

We  found  no  trace  of  an  abscess  round  the  pubes. 

An  interesting  point  was  that  both  the  dorsal  and  the  lumbar 
vertebrae  showed  a  small  amount  of  overlipping  owing  to  the 
development  of  new  bone  along  the  upper  and  lower  anterior 
borders  of  the  body.  The  disease  here  had  evidently  begun  in  the 
bone,  for  the  intervertebral  discs  and  the  ligaments  showed  no  signs 
of  ossification. 

It  is  certain  that  this  woman  had  been  long  bedridden,  possibly 
owing  to  the  pelvic  disease,  as  there  was  a  huge  bedsore  in  the 
lumbar  region,  in  which  micro-organisms  were  found  in  enormous 
numbers. 

The  Coptic  sacrum  (Plate  XXXI,  Fig.  57)  showed  a  curious 
malformation.  The  first  sacral  foramen  was  not  closed  by  bone 
internally,  and  a  deep  spoon-shaped  fissure  extended  right  away  to 
the  sacral  canal.  There  were  no  signs  of  inflammation  along  the 
fissure,  and  we  may  suppose  that  it  was  due  to  congenital  deforma- 
tion. 

SUMMARY  AND  GENERAL  CONSIDERATIONS 

The  majority  of  the  lesions  discovered  in  the  skeletons  of  old 
Egyptians,  coming  from  a  period  extending  over  more  than  three 
thousand  years,  were  typical  of  chronic  arthritis.  The  spinal 
column  was  most  often  the  seat  of  the  disease,  the  alterations 
varying  from  slight  overlipping  to  complete  ankylosis,  sometimes 


n6         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

accompanied  by  lesions  of  the  sacro-iliac  articulation  and  of  the 
long  bones  of  the  lower,  more  seldom  by  changes  in  the  long  bones 
of  the  upper,  extremities. 

The  frequency  with  which  the  bones  of  the  hand  and  the  foot 
are  affected  could  unfortunately  not  be  estimated,  as,  in  the  major- 
ity of  cases,  it  was  not  possible  to  say  with  certainty  to  what 
skeleton  the  bones  belonged.  Although  the  number  of  diseased 
smaller  bones  was  certainly  small,  yet  it  is  a  peculiar  fact  that,  in 
almost  every  case  where  the  whole  or  the  larger  part  of  the  skeleton 
was  found,  the  phalanges  were  also  altered  by  osteo-arthritis,  though 
the  lesions  were  slight  as  a  rule.  On  the  whole,  it  would  appear 
that  the  foot  was  more  often  affected  than  the  hand. 

Lesions  of  the  carpal  bones  were  never  seen,  and  those  of  the 
tarsus  were  very  rare. 

In  many  cases  the  fasciae,  the  insertions  of  muscles,  or  the 
muscles  themselves  were  certainly  invaded  by  the  ossifying  process. 
This  is  well  shown  in  a  skeleton  of  the  Illrd  Dynasty,  where  a  bony 
mass,  which  had  evidently  developed  in  the  muscles  and  tendons, 
occupied  the  vertebral  groove.  Slighter  pathological  changes,  such 
as  small  osteophytes  at  the  insertion  of  muscles  and  fasciae  (e.g., 
insertion  of  the  plantar  fascia,  great  trochanter,  etc.),  though  less 
demonstrative,  point  to  the  same  conclusion.  It  is  certain  also 
that  the  lesions  were  present  far  oftener  than  our  examination 
showed,  as  all  the  smaller  osteophytes,  etc.,  must  have  been  broken 
off  and  could  not  be  discovered  in  the  sand  of  the  graves. 

The  complete  or  partial  ankyloses  of  the  sacro-iliac  articulations 
may  be  assumed  to  have  been  caused  by  the  same  disease  as  the 
spondylitis  deformans.  In  our  opinion  it  is  very  doubtful  whether 
lesions  such  as  are  shown  in  Plate  XXX,  Figs.  48,  50,  and  51,  should 
not  be  classed  in  a  separate  category.  In  these  cases  the  pathologi- 
cal process  is  conspicuous,  not  so  much  in  the  joint  as  on  the  flat 
surfaces  of  the  bones. 

Nowadays  the  tendency  is  to  think  that  the  lesions  of  chronic 
arthritis  are  due  either  to  a  chronic  infectious  process  or  follow  on 
an  acute  infectious  disease.  Assuming  this  theory  to  be  true,  we 
cannot  say,  nevertheless,  to  what  infectious  disease  the  osteo- 
arthritic  lesions  of  old  Egyptians  were  due.     That  the  old  Egyptians 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  117 

suffered  from  bacterial  diseases,  identical  with  those  seen  now,  has 
been  shown  by  the  investigations  of  Elliot  Smith,1  Ruffer,2  and 
Ferguson,3  but  we  do  not  know  what  was  the  incidence  of  such 
diseases  in  Egypt.  Until  that  is  ascertained,  the  etiology  of  the 
osteo-arthritic  lesions  of  old  Egyptians  cannot  be  even  guessed   at. 

Undoubtedly,  however,  the  manner  in  which  the  disease  spreads 
along  the  spine  points  to  its  having  been  due  to  a  chronic  infectious 
process  occasionally  giving  rise  to  metastases  in  other  articulations. 

We  could  not  get  any  definite  evidence  as  to  whether  the  disease 
was  more  common  in  man  than  in  woman. 

Certainly  the  malady  was  one  occurring  more  frequently  in  old 
than  in  young  people.  The  "determinative"  of  old  age,  for 
instance,  in  hieroglyphic  writing  is  the  picture  of  a  man  deformed 
from  chronic  arthritis.  That  it  occurred  among  people  in  early 
adult  life  is  shown  by  the  fact  that  typical  lesions  were  discovered  in 
two  young  people  who  had  not  yet  cut  their  wisdom  teeth. 

Dr.  Elliot  Smith  and  Dr.  Wood  Jones  had  already  drawn  atten- 
tion to  the  frequency  with  which  arthritis  deformans,  and  especially 
spondylitis  deformans,  occurred  in  Old  Egypt.  Dr.  Wood  Jones4 
in  his  monograph  on  the  subject  expresses  himself  as  follows: 

The  causal  factor  of  the  disease  is  essentially  one  of  environment  and 
not  of  race;  it  is  the  conditions  of  life  in  the  Nile  Valley  at  all  those  periods 
from  which  the  remains  of  man  have  been  studied,  which  have  produced  the 
development  of  such  a  common  disease. 

The  foreign  Christians  who  came  to  Philae  in  the  early  centuries  of  the 
Christian  era,  and  left  their  remains  in  such  quantities  in  the  cemeteries  on 
the  islands  of  Biga  and  Hera,  were  subject  to  the  disease,  although  it  was  not 
so  universal  in  them  as  in  the  indigenous  population  of  the  older  cemeteries. 

The  present  inhabitants  of  Nubia  are  also  afflicted  with  the  disease 

Among  the  modern  Egyptians  also  the  signs  of  the  osteo-arthritic  changes  do 
occur.  .  .  ._.  It  is  probable,  therefore,  that  the  disease  is  associated  with  the 

1  Grafton  Elliot  Smith  and  Marc  Armand  Ruffer,  "Pott'sche  Krankheit  an  einer 
agyptischen  Mumic,"  Zur  historiscken  Biologic  dcr  Kranhhcitscrrcger ,  Heft  3. 

1  Marc  Armand  Ruffer,  "Remarks  on  the  Histology  and  Pathological  Anatomy  of 
Egyptian  Mummies,"  Cairo  Scientific  Journal,  Vol.  IV  (January,  1910),  No.  40. 

J  Marc  Armand  Ruffer  and  A.  R.  Ferguson,  "Note  on  an  Eruption  Resembling 
That  of  Variola  in  the  Skin  of  a  Mummy  of  the  Twentieth  Dynasty  (1 200-1 100  B.C.)," 
Journal  of  J'atlwlogy  and  Bacteriology,  Cambridge,  XV,  1. 

*  Tlic  Archaeological  Survey  of  Nubia,  Report  for  1907-8,  II,  273. 


n8         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

country  of  the  Nile  Valley  and  the  mode  of  life  of  its  population.  Although 
the  people  whose  remains  have  been  examined  vary  in  their  racial  characters, 
the  Egyptians,  Negroes,  and  a  foreign  element  from  the  Eastern  Mediterranean 
are  all  represented,  still  it  is  probable  that  the  habits  and  mode  of  life  of  these 
races,  when  once  they  had  become  inhabitants  of  the  Nile  Valley,  did  not 
greatly  differ. 

At  all  periods  the  Nile  was  the  chief  factor  in  their  lives;  it  gave  them 
their  livelihood  and  supplied  their  wants,  and  it  probably  gave  them  then,  as 
it  gives  them  now,  the  bulk  of  their  diseases.1 

Every  member  of  the  riverside  population  has  it  as  his  birthright  that  a 
great  part  of  his  whole  life  shall  be  spent  dabbling  in  the  water  of  the  Nile, 
even  at  those  times  of  cold  which  are  not  at  all  uncommon  during  the  Nubian 
winter.  The  men,  for  their  ablutions,  their  fishing,  and  their  many  processes 
of  irrigation,  are  forced  to  spend  much  of  their  time  in  and  out  of  the  water; 
and  the  women  of  a  Nubian  household  are  never  free  from  the  constant  duty 
of  filling  their  waterpots  at  the  river. 

It  may  be  this  exposure,  with  the  alternate  wetting  and  drying  in  a  climate 
which  may  be  of  severe  cold  or  intense  heat,  that  has  produced,  and  is  producing 
this  remarkable  frequency  of  osteo-arthritic  changes  in  these  people. 

The  theory  propounded  by  Dr.  Wood  Jones  is  practically  the 
once  fashionable  theory  that  osteo-arthritis  is  due  to  wet  and  cold. 
He  argues  that  the  men  and  women  in  Nubia  having  been  exposed 
to  heat,  cold,  and  wet  in  their  occupations,  therefore  the  osteo- 
arthritic  changes  were  due  to  these  conditions. 

As  far  as  temperature  is  concerned,  extremes  of  heat  and  cold 
are  met  with  in  every  country,  and  not  in  Nubia  only.  It  is  true 
that  the  differences  between  the  night  and  day  temperature  are 
very  great,  but  they  are  hardly  felt  by  human  beings  who  spend 
their  nights  in  houses  or  caves.  Moreover,  the  exposure  to  wet 
owing  to  their  occupations  is  the  rule  among  all  agricultural,  fishing, 
or  hunting  people,  and  could  not  therefore  account  for  the  appar- 
ently greater  frequency  of  osteo-arthritis  in  Nubia.  The  exposure 
of  the  agricultural  population  of  Egypt  to  wet  is  almost  limited  to 
the  hands  and  feet,  which  are  quickly  dried  as  soon  as  the  work  is 
finished.  It  is  not  to  be  compared  as  an  etiological  factor  with 
the  thorough  drenching  that  a  European  labourer  gets  several  times 
a  year,  and  who  often  cannot  change  his  clothes  for  some  time. 

1  This  statement  we  cannot  allow  to  pass  without  pointing  out  that  the  evidence  in 
favour  of  it  is  by  no  means  conclusive. 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  119 

Our  observations  at  Alexandria  show  that  the  race  cannot  have 
had  anything  to  do  with  the  etiology  of  the  disease,  and  there  are 
also  evidences  that  climate  as  such  has  no  part  in  it. 

It  would  indeed  be  difficult  to  find  a  greater  contrast  between 
the  temperate,  moist,  marine  climate  of  Alexandria,  with  its  con- 
stant sea  breezes,  heavy  winter  rainfalls,  mild  summer,  warm  nights, 
with  the  Nubian  desert  climate,  characterised  by  scorching  days, 
cold  nights,  and  excessive  dryness. 

Further,  our  observations  show  that  occupation  does  not  appear 
to  have  had  anything  to  do  with  the  causation  of  the  disease.  The 
Nubians  were  for  the  most  part  agriculturists,  the  Alexandria  people 
soldiers  or  townspeople,  and  there  is  no  reason  why  the  latter  at  any 
rate  should  have  dabbled  in  water.  The  Nile  did  not  flow  at  Alex- 
andria, and  the  enormous  Roman  cisterns  even  now  in  existence 
show  that  water  was  a  precious  article,  and  that  there  was  none  to 
waste,  as  in  Nubia.  Even  allowing,  therefore,  that  the  Greek 
soldiers  might  have  contracted  this  disease  owing  to  exposure  to 
wet  and  cold  during  their  campaigns,  this  theory  cannot  account 
for  the  frequency  of  this  disease  in  townspeople. 

A  further  argument  against  the  theory  that  osteo-arthritis  in 
the  past  was  due  to  exposure  is  that  pet  animals,  carefully  kept  in 
temples,  suffered  a  great  deal  from  the  same  or  a  similar  disease. 
Lortet  and  Galliard,  for  instance,1  have  described  like  lesions  in 
monkeys  at  Thebes,  perhaps  one  of  the  driest  spots  in  the  world, 
and  situated  miles  away  from  the  Nile.2 

We  cannot  agree  with  Poncet  that  these  lesions  are  due  to 
tubercle,  for  they  present  none  of  the  appearances  of  that  disease. 

Indeed,  except  for  one  very  doubtful  case,  we  have  not  come 
across  one  single  bone  showing  the  typical  lesions  of  tubercle. 
Strange  to  say,  lesions  indicating  the  presence  of  rickets  or  syphilis 
were  completely  absent. 

Lastly,  we  must  not  forget  that  it  is  quite  possible  that  further 
investigations  may  show  that  during  that  period  which  we  have 

1  See  Lafaune  motnifiic  de  I'ltgyptc,  S6rie  II,  p.  26. 

'  One  of  us  (M.  A.  R.)  has  seen  a  gazelle,  born  in  captivity  in  Egypt,  and  which  had 
never  been  exposed  to  wet  and  cold,  which  presented  the  typical  symptoms  of  arthritis 
deformans. 


STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 


studied,  osteoarthritis  was  as  common  in  other  countries  as  it  was 
in  Egypt. 

TEETH  OF  GREEK  PERIOD 

A  difficulty  presented  itself  in  estimating  the  percentage  of 
dental  disease  owing  to  the  fact  that  many  teeth  dropped  out  after 
death  and  could  not  be  found.  As  a  rule,  therefore,  we  were  obliged 
to  consider  as  diseased  only  such  teeth  the  alveoli  of  which  showed 
partial  or  complete  absorption.  Far  from  overstating  the  number 
of  diseased  teeth,  we  have  therefore  certainly  done  the  reverse,  for 
the  majority  of  teeth  showing  only  slight  signs  of  decay  perforce 
escaped  our  notice. 

The  following  tables  give  the  number  of  diseased  teeth  in  the 
upper  and  lower  jaws : 

UPPER  MAXILLA 
N.B.:  +  indicates  that  a  tooth  was  present  but  decayed. 


Register 

Incisors 

Canines 

Premolars 

Molars 

R. 

L. 

R. 

L. 

R. 

L. 

R. 

L. 

Remarks 

J 

Ch.  G 

Ch.  A.  I 

Ch.  A 
Ch.  G.  II 
Ch.  L 

Ch.  B 

Ch.  Y 

Ch.  Y.  II 

Ch.  Ill 

Ch.  G.  Ill 

Ch.  IV 

Ch.  V 
Ch.  VI 

Ch.  VII 

Ch.  VIII 

only  cut  through. 

feet. 

ISt 

5 

and  perfect. 

slightly  worn. 

worn. 

9 

ISt 

ISt 

2d 
3d 

ISt 

2d 
3d 

ISt 
ISt 

2d 
3d 

united,  but  not  the  others. 
In  connection  with  the 
missing  tooth  there  had 
been  an  abscess,  which  had 
perforated  through  the 
palate. 

I  St 

2d 

ISt 

2d 

' 

* 

ISt 

2d 

2d 

worn,  but  not  carious. 

Old  man;  all  alveoli  com- 
pletely obliterated,  except 
first  left  premolar. 

13 

ISt 

2d 

1 

ISt 

2d 

ISt 

2d 

ISt 

2d 
3d 

ISt 

2d 
3d 

ISt  + 

2d 
3d+ 
2d 
3d 

very  white  teeth  present. 
Adult,  but  not  old;    basilar 
and  frontal  sutures  ossi- 
fied, but  not  the  others. 

IS 

ISt  + 

2d 

2d 
3d 

literated,  but  not  the 
others. 

deeply  carious,  and  pushed 
forwards  by  periostal  in- 
flammation behind  the 
fangs. 

ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS 


UPPER  MAXILLA— Continued, 
N.B.:  +  indicates  that  a  tooth  was  present  but  decayed. 


Register 

Incisors 

Canines 

Premolars 

Molars 

R. 

L. 

R. 

L. 

R. 

L. 

R. 

L. 

Ch.DC 

Ch.  X 
Ch.  XI 
Ch.  XII 
Ch.  XIII 
Ch.XIV 
Ch.  XV 
Ch.  XVI 
Ch.  XVIII 

1st 
2d 

1st 

tied,  others  only  partially 

ISt-f 

ISt 

2d 

3d 

I  St 

2d 
3d 

teeth  only,  already  much 

* 

2d 

2d 

suture  ossified,  all  others 
open. 

suture  not  quite  ossified. 

2d 

1st 

1st 
3d 

basilar  suture  not  ossified; 
all  others  not. 

suture  except  basilar  un- 
closed. 

23 

suture  not  closed;  teeth 
beautifully  white. 

1  + 

2d 

2d  + 

teeth  only,  beautifully 
kept. 

SUMMARY 

Number  of  right  1st  incisors  missing 2 

Number  of  left  1st  incisors  missing 2 

Number  of  right  2nd  incisors  missing 2 

Number  of  left  2nd  incisors  missing 1 

Number  of  right  canines  missing 3 

Number  of  left  canines  missing 2 

Number  of  right  1st  premolars  missing 3 

Number  of  left  1st  premolars  missing 3 

Number  of  right  2nd  premolars  missing 5 

Number  of  left  2nd  premolars  missing 5 

Number  of  right  1st  molars  missing 6 

Number  of  left  1st  molars  missing 6 

Number  of  right  2nd  molars  missing 6 

Number  of  left  2nd  molars  missing 5 

Number  of  right  3rd  molars  missing 5 

Number  of  left  3rd  molars  missing 6 

Our  tables  are  of  comparative  value  only;  nevertheless,  the 
results  of  our  observations  are  so  definite  that  they  may  find  a 
place  here. 


122         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 


Out  of  twenty-four,  twelve  had  good  teeth,  but  it  must  be 
remembered  that  many  were  young  people. 

The  table  shows  that  in  those  times,  as  now,  the  molars  suffered 
most,  and  especially  the  third  molar.  Of  twenty  cases  in  which 
the  molars  had  been  cut,  no  less  than  seven  had  lost  one  or  both 
wisdom  teeth. 

In  the  lower  jaw  the  same  deficiencies  in  the  teeth  are  observed, 
namely,  the  molars  have  disappeared  more  often  than  any  other 
teeth.  The  third  molar  especially  has  suffered  a  great  deal,  no  less 
than  six  people  having  lost  one  or  both  wisdom  teeth. 

MANDIBLE 
N.B.:  +  indicates  that  a  tooth  was  present  hut  decayed. 


No. 

Register 

Incisors 

CANrNES 

Premolars 

Molars 

Remarks 

R. 

L. 

R. 

L. 

R. 

L. 

R. 

L. 

Ch.x 
Ch.  B 

Ch.  G 
Ch.  A.  II 
Ch.g 
Ch.  a.  Ill 
Ch.  d 
Ch.  A.  I 

Ch.E 
Ch.  G.  I 

Ch.  I 

Ch.  n 

Ch.  D 
Ch.  D.  I 
Ch.  0 
Ch.  D.  II 
Ch.  Y 
Ch.  B 
Ch.  C 

Ch.  VII 

Ch.X 

Ch.  A.  IV 

Ch.  D.  Ill 

ISt 

ISt 

2d 
3d 

3 

4 

5 

ISt 

left  ramus  only  present. 
Part  of  right  ramus  only; 

1 

ISt 

teeth  clear  and  white. 

7 

with  left  canine. 

2d 
3d+ 

with  outer  fang  of  right 
second   molar.      Alveolus 
filled  with  bone. 

perfect. 

ible  lesions. 

13 

14 

2d 

ISt 

2d+ 

molars  just  erupting;  teeth 
good,  not  worn. 

ISt  + 

Right  ramus  only. 

Wisdom  teeth  not  out  yet. 

Left  ramus,  teeth  not  worn. 

19 

1 

2d 

2d 
3d 

ISt 

2d 

3d 

ISt 

3d 

ISt 

2d 
3d 

absent. 
Much  tartar;   teeth  yellow. 

not  worn. 
No  wisdom  teeth  on  right 

ad 

ISt 

2d 

2d 
ISt 

2d 

ISt 
ISt 

2d 
3d 

side. 
An  impacted  tooth  behind 

23 

ISt 

2d 

ISt 

left  second  molar;  distinct 
swelling  of  ramus  in  that 
position. 
Very    powerful    jaw;     evi- 
dently male. 

ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  123 

SUMMARY 

Number  of  right  central  incisors  missing o 

Number  of  left  central  incisors  missing 1 

Number  of  right  lateral  incisors  missing o 

Number  of  left  lateral  incisors  missing 1 

Number  of  right  canines  missing 1 

Number  of  left  canines  missing 2 

Number  of  right  1st  premolars  missing 2 

Number  of  left  1st  premolars  missing 1 

Number  of  right  2nd  premolars  missing 2 

Number  of  left  2nd  premolars  missing 4 

Number  of  right  1st  molars  missing 5 

Number  of  left  1st  molars  missing 5 

Number  of  right  2nd  molars  missing 2 

Number  of  left  2nd  molars  missing 5 

Number  of  right  3rd  molars  missing 2 

Number  of  left  3rd  molars  missing 5 

There  are  several  other  points  of  interest,  which  are  revealed 
by  the  examination  of  the  teeth. 

In  a  few  cases  an  abscess  in  connection  with  one  of  the  teeth  had 
formed.  These  abscesses  in  every  case  had  penetrated  deeply  into 
the  bone  or  had  perforated  into  the  palate,  and  yet  in  severe  cases 
apparently  nothing  had  been  done  to  relieve  the  patient  of  the  pain, 
which  must  have  been  agonising.  In  two  cases  the  offending  tooth, 
although  loose,  was  still  present  in  the  alveolus. 

In  almost  every  book  on  ancient  Egyptian  medicine  one  reads 
of  the  Egyptians  being  learned  in  dentistry,  yet  judging  from 
these  and  other  observations  they  often  did  not  pull  out  a  painful 
tooth,  an  operation  of  all  surgical  operations  certainly  the  most 
obvious. 

We  have  never  found  the  slightest  evidence  that  the  Egyptians 
knew  anything  about  filling  teeth,  though  in  more  than  one  treatise 
it  is  stated  that  they  were  skilled  in  this  science.  Lastly,  we  have 
never  seen  artificial  teeth  except  in  one  instance,  which  was  shown 
us  by  our  friend,  Professor  Breccia.  A  number  of  teeth  were  bound 
together  by  gold  wire,  and  were  found  in  a  Roman  tomb  in  Egypt. 
It  is  evident,  however,  that  this  apparatus  was  for  show  and  not 
for  use,  as  it  could  not  possibly  have  been  used  for  mastication. 


124         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  examination  of  the  teeth  shows  that  the  quality  of  the  food 
was  different  from  what  it  was  in  Upper  Egypt  in  early  times.  The 
teeth  are,  with  few  exceptions,  not  worn  down  by  the  coarse  vege- 
table food  of  the  fellah,  but  the  crowns  are,  as  a  rule,  perfect  save 
in  very  old  people.  The  food  was  therefore  soft,  and  consisted 
probably  chiefly  of  meat. 

Many  of  the  people  used  the  tooth-brush  or  some  similar  instru- 
ment freely.  Deposits  of  tartar  are  rare,  and  as  a  rule  the  teeth 
are  beautifully  white  and  clean. 

We  have  also  often  been  struck  with  the  small  size  of  the  wisdom 
teeth.  In  this  connection  we  may  refer  to  Darwin's  remarks1  on 
the  subject  of  the  third  molar  teeth.  "It  appears  as  if  the  posterior 
molar  or  wisdom  tooth  were  tending  to  become  rudimentary  in  the 
more  civilised  races  of  man.  These  teeth  are  rather  smaller  than 
the  molars,  ....  and  they  have  only  two  separate  fangs."2 

He  also  refers  to  a  letter  from  Professor  Mantegazza  in  which 
this  observer  states  that  "in  the  higher  or  civilised  races  they  are 
on  the  road  towards  atrophy  or  elimination." 

Morton  Small  and  J.  F.  Colyer3  express  themselves  as  follows: 

At  the  present  time  the  first  permanent  molars  are  more  prone  to  caries 
than  other  teeth,  and  the  mandibular  more  than  the  maxillary.  The  second 
molars  probably  follow  the  first  molars  in  liability  to  caries,  the  mandibular 
being  attacked  with  more  frequency  than  the  maxillary.  It  is  extremely 
difficult  without  reliable  statistics  to  place  the  incisors  and  premolars  as  regards 
their  liability  to  caries.  Judging  from  experience,  there  seems  little  to  choose 
between  the  first  and  second  maxillary  premolars  in  this  respect,  but  with 
regard  to  the  mandibular  premolars  the  liability  to  caries  is  much  more  marked 
in  the  second  than  in  the  first.     The  mandibular  incisors  are  comparatively 

immune  to  caries The  liability  of  the  third  molars  to  caries,  in  mouths 

where  all  the  teeth  are  present,  is  attributable  to  difficulty  in  keeping  them 
free  from  food  debris. 

1  Descent  of  Man,  p.  20. 

2  Darwin  appears  to  have  been  under  a  misapprehension  in  this  respect.  Quain's 
Anatomy,  II  (18S2),  549,  states:  "In  the  wisdom  teeth  of  both  jaws  the  fangs  are  often 
collected  into  a  single  irregular  conical  mass,  which  is  either  directed  backwards  in 
the  substance  of  the  jaw  or  curved  irregularly;  this  composite  fang  sometimes  shows 
traces  of  subdivision,  and  there  are  occasionally  two  fangs  in  the  lower  tooth  and  three 
in  the  upper." 

3  Diseases  and  Injuries  of  the  Teeth. 


ON  OSSEOUS  LESIONS  IN  ANCIENT  EGYPTIANS  125 

Our  observations,  as  far  as  they  go,  show  that  the  liability  of 
particular  teeth  to  disease  in  Greek  times  was  much  the  same  as  it 
is  now,  except  that  the  third  molar  was  perhaps  more  often  affected 
than  it  is  at  the  present  day. 

Without  entering  into  the  question  as  to  whether  these  facts  do 
or  do  not  favour  the  idea  advanced  by  Darwin,  we  would  point  out 
that  all  these  characteristics  existed  more  than  two  thousand 
years  ago. 

DESCRIPTION  OF  PLATES  XXIII-XXXI 

(For  particulars  see  text) 

plate  xxm 

Figs.  1-5. — From  skeleton  of  Illrd  Dynasty. 

plate  xxrv 

Figs.  6,  7. — From  same  skeleton  as  Figs.  1-5. 

Figs.  8-16. — From  another  skeleton  of  the  Illrd  Dynasty. 

plate  xxv 

Fig.  17. — From  a  skeleton  of  the  Xllth  Dynasty,     (a)  Points  to  osteo- 
phyte growing  between  ninth  and  tenth  dorsal  vertebrae. 
Figs.  18-22. — From  a  mummy  of  the  XXIst  Dynasty. 
Fig.  23. — Metatarsal  bone  from  a  mummy  of  the  XXIst  Dynasty. 

plate  xxvi 

Figs.  24-26. — From  a  skeleton  of  the  XXIInd  Dynasty. 

Figs.  27-29. — From  a  skeleton  dating  from  the  Persian  occupation  of 
Egypt. 

Figs.  30  and  31. — Bouchard's  nodosities.  From  a  skeleton  dating  from 
the  Persian  occupation  of  Egypt. 

plates  xxvn-xxix 

Figs.  32-35. — From  skeletons  of  soldiers  of  Alexander  the  Great. 
Fig.  36. — Radius  of  skeleton  of  XXIst  Dynasty. 
Figs.  37-45. — From  skeletons  of  soldiers  of  Alexander  the  Great. 
Figs.  46  and  47. — Fracture  of  both  bones  of  the  leg.     From  a  mummy  of 
the  time  of  the  Persian  occupation. 

plate  xxx 

Figs.  48  and  49. — From  skeletons  of  soldiers  of  Alexander  the  Great. 
Fig.  50. — From  a  Coptic  skeleton,     (a)  Points  to  a  deep  groove  between 
the  old  and  newly  formed  bone. 


126         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Fig.  si. — From  a  skeleton  of  Roman  times,     (a)  Points  to  bony  excres- 
cences. 

Figs.  52  and  53. — From  skeletons  of  soldiers  of  Alexander  the  Great. 

PLATE  XXXI 

Fig.  54. — From  a  skeleton  of  Roman  times. 
Fig.  55. — Exostosis  on  rib  of  a  soldier  of  Alexander  the  Great. 
Fig.  56. — Lower  jaw  with  alveolar  abscess  of  a  soldier  of  Alexander  the 
Great. 

Fig.  57. — From  a  Coptic  skeleton. 

Figs.  18-61. — From  a  skeleton  of  Roman  times. 


PLATE  XXIII 


PLATE  XXV 


PLATE  XXVI 


PLATE  XXVII 


PLATE  XXVIII 


PLATE  XXIX 


PLATE  XXX 


PLATE  XXXI 


NOTES  ON  TWO  EGYPTIAN  MUMMIES  DATING  FROM 

THE  PERSIAN  OCCUPATION  OF  EGYPT1 

(525-332    B.C.) 

{Bulletin  de  la  Societe  Archeologique  d'Alexandrie, 
No.  14  [1912]) 

In  spite  of  numerous  works  on  embalming,  but  few  facts  are 
known  regarding  this  process,  for  with  a  few  brillant  exceptions, 
such  as  Pettigrew,  Maspero,  Fouquet,  Elliot  Smith,  Derry,  Wood 
Jones,  most  writers  have  been  content  to  copy  ancient  or  modern 
textbooks,  and  have  added  little  that  is  new  to  our  knowledge. 

We  do  not  intend  to  give  here  an  account  of  methods  of  embalm- 
ing, but  merely  to  put  on  record  two  observations  which  appear 
to  us  to  be  of  some  interest. 

The  two  mummies  to  be  described  now  were  given  us  by  Profes- 
sor W.  M.  Flinders  Petrie,  who  informed  us  that  they  belonged  to 
the  date  of  the  Persian  occupation  of  Egypt. 

MUMMY   NO.    I 

The  first  mummy  was  that  of  a  woman,  and  we  give  here  the 
notes  taken  during  its  examination. 

NOTES   OF  EXAMINATION 

Mummy  very  light.  Length,  when  unrolled,  1  metre  50  centi- 
metres. On  unrolling,  the  following  layers  of  bandages  presented 
themselves: 

1.  External  surface  of  shroud  (Plate  XXXII,  Fig.  1),  adorned 
with  small  bandages  2 . 8  centimetres  in  breadth,  most  of  which, 
however,  had  been  torn  away.  Remaining  bandage  wound  twice 
round  the  neck.  Some  small  pieces  of  cartonnage  still  left  over 
neck  and  lower  part  of  legs. 

2.  Broad  longitudinal  band  passing  over  head  to  centre  of  back, 
where  it  was  lost  in  a  lump  of  gum. 

■  This  paper  was  written  with  A.  Rietti  as  junior  author. 
127 


128         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

This  band,  20  centimetres  in  breadth,  was  split  into  two,  near 
the  feet,  each  of  these  two  pieces  going  round  feet,  and  then  running 
up  over  head  to  back,  which  was  greatly  soiled  with  gum. 

3.  Large  number  of  linen  rags  (Plate  XXXII,  Fig.  2.),  which 
had  been  forced  between  the  legs  and  laid  over  the  abdomen;  also 
forcibly  pushed  between  side  of  head  and  bandages  passing  from 
head  to  shoulder.  Back  also  covered  by  a  large  number  of  similar 
rags  greatly  begrimed  with  gum. 

4.  Body  lying  with  legs  fully  extended  and  arms  crossed,  right 
arm  over  left.  Bandage  (Plate  XXXII,  Fig.  3),  4  centimetres 
broad,  passed  several  times  round  body,  both  arms,  over  legs  and 
finally  tied  round  feet. 

5.  Piece  of  linen  forming  a  shroud  over  the  legs,  arms,  abdomen, 
and  chest. 

6.  Whole  mummy,  from  head  to  feet,  was  now  seen  to  be  a 
model  of  beautiful  bandaging. 

Bandages  made  of  rather  coarse  linen.  One,  obtained  entire, 
measure  6  metres  in  length  and  2  . 8  centimetres  in  breadth.  Free 
end  fringed  like  a  scarf;  the  other  end  hemmed,  showing  that  it 
had  been  torn  off  from  a  piece  of  cloth  6  metres  long,  the  breadth 
of  which  we  could  not  ascertain. 

Head  held  in  position  by  bandage  passing  over  vertex,  round 
one  side  of  the  neck,  over  the  head  again,  and  again  on  the  other 
side  of  the  neck.  Finally,  several  turns  round  the  forehead  kept 
all  these  bandages  together.  Over  the  face,  bandages  looked  pink 
and  white  alternately;  an  appearance  produced  by  small  strips  of 
pink  linen  placed  under  each  bandage,  each  of  which  overlapped  the 
white  bandages  for  about  half  a  centimetre.  Strips  of  pink  linen 
had  been  neatly  tied  just  above  each  wrist,  elbow,  ankle,  and  knee, 
forming  bracelets  or  anklets. 

Bandages  ran  up  in  figures  of  eight,  over  the  chest  and  round 
the  shoulders,  and  again  from  the  toes,  legs,  round  the  abdomen 
and  groins,  just  as  surgical  bandages  are  applied  now  for  wounds 
in  the  same  regions.     No  reverses  anywhere. 

Exact  method  of  bandaging  the  abdomen  and  chest  not 
ascertainable,  owing  to  soiling  of  back  by  gum. 

Fingers  were  not  bandaged,  but  enclosed  in  a  piece  of  linen 
covering  the  whole  hand.     Nails  of  fingers  (but  not  of  toes)  (Plate 


NOTES  ON  TWO  EGYPTIAN  MUMMIES  129 

XXXIII,  Fig.  4)  tied  on  by  little  pieces  of  string,  in  the  same 
manner  as  has  been  described  by  Professor  Elliot  Smith  in  mum- 
mies of  the  XXIst  Dynasty. 

7.  After  removal  of  bandages,  the  mummy  was  found  to  be 
covered  by  a  long  broad  piece  of  linen,  entirely  encasing  it  (Plate 

XXXIV,  Fig.  s). 

8.  Bandages  running  irregularly  over  the  body  and  legs,  holding 
together  flat  strips  of  linen,  measuring  14  centimetres,  placed  in 
various  positions  as  a  padding,  plainly  in  order  to  simulate  the 
shape  of  the  body.  These  strips  most  numerous  on  inner  surface 
of  thighs,  on  calves  and  chest,  round  neck  and  underneath  chin. 
They  were  always  put  in  perfectly  flat,  and  from  the  way  in  which 
they  were  placed  it  appears  probable  that  one  person  endeavoured 
to  imitate  the  shape  of  the  thighs,  legs,  etc.,  by  holding  these  strips 
of  linen  in  position,  while  another  bandaged  over  them.  On  one 
hand,  bandages  kept  in  position  by  passing  through  interdigital 
spaces  of  second  and  third  fingers. 

9.  Near  the  skin,  bandages  intensely  black  from  gum,  hard,  and 
brittle.  It  was  impossible  to  follow  them,  but  one  had  the  impres- 
sion that  a  very  fine  piece  of  linen  had  been  first  placed  all  along 
the  skin.  The  pieces  had  to  be  picked  away  bit  by  bit,  until  the 
skin  underneath  was  exposed. 

10.  At  the  back,  after  picking  away  the  bandages  from  top  and 
bottom,  one  came  in  the  centre  of  the  back  to  a  mass  of  coarse  linen 
saturated  with  gum  and  so  hard  that  it  was  impossible  to  remove 
it  (Plate  XXXV,  Fig.  6a).  Here  the  skin  and  muscles  had 
entirely  disappeared.  Plainly  a  large  hole  at  the  back  had  been 
filled  up  by  linen  saturated  with  gum. 

11.  The  body  now  looked  extraordinarily  thin.  The  skin  was 
so  brittle  that  in  spite  of  every  possible  care  holes  were  made  in 
wall  of  abdomen.  After  a  search  lasting  several  hours,  the  line 
of  the  incision  in  the  left  flank  was  found,  a  piece  of  linen  which 
was  still  sticking  between  the  edges  of  the  wound  proving  a 
guide  to  it. 

12.  Body  jet-black,  in  some  places  almost  of  a  slaty  colour. 
The  chest  and  abdomen  look  just  as  if  painted  with  black  shiny 
varnish  (Plate  XXXIV,  Fig.  7). 


130         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Head  was  cleaned  with  difficulty  owing  to  linen  closely  attached 
to  skin.  Strips  of  rag  had  been  put  behind  the  ears,  and  bandages 
so  arranged  as  to  press  ears  forward  (Plate  XXXVI,  Fig.  8) .  The 
top  of  the  head  was  clean-shaved. 

Very  peculiar  appearance  was  presented  by  mouth,  its  left 
angle  being  distinctly  depressed  (Plate  XXXVI,  Fig.  8).  Right 
angle  normal  apparently,  but  tongue  protruded  for  about  half  a 
centimetre,  and  strongly  indented  by  teeth.  Mouth  contained  no 
foreign  matter.  Eyelids  jet-black  just  as  if  they  had  been  varn- 
ished. Eyebrows  could  not  be  recognised,  but  eyes  themselves 
were  easily  seen,  the  globes  not  having  been  removed.  Eyelashes 
perfect. 

13.  Front  of  abdominal  walls  and  chest  now  cut  away  bit  by  bit 
with  scissors.  The  genital  organs  had  been  removed,  and  a  round, 
sacklike  piece  of  stiff  linen,  filled  with  some  vegetable  powder  and 
about  3  inches  in  diameter,  had  been  rammed  into  the  pelvic  cavity 
through  the  perineum.  This  had  plainly  been  put  there  in  order  to 
close  the  cavity. 

14.  Spine  had  been  fractured  just  above  the  second  lumbar 
vertebra.  The  first  lumbar  vertebra  found  lying  almost  behind  the 
second.     The  sacrum  looked  almost  horizontally  backwards. 

Dorsal  vertebrae  seen  vaguely  at  bottom  of  wound,  but  extra- 
ordinarily black,  very  unlike  the  lumbar  vertebrae  below.  A  piece 
of  stick  (the  rib  of  a  palm  leaf)  had  been  put  in  vertically  and  was 
resting  just  below  and  behind  Poupart's  ligament  on  right  side  and 
on  first  rib  above.  This  can  only  have  been  introduced  through 
the  perineum  by  the  embalmer,  and  had  evidently  been  put  in  to 
prevent  collapse  of  body  (Plate  XXXVI,  Fig.  8). 

Absolutely  no  trace  of  any  internal  organ  could  be  found.  The 
whole  of  the  abdominal  cavity  was  lined  everywhere  by  a  black, 
hard,  glistening  substance,  which  posteriorly  formed  a  layer  almost 
2  inches  thick.  There  were  also  a  few  thick  pieces  of  coarse  rag 
crammed  into  right  iliac  fossa,  and  just  above  and  behind  the 
second  lumbar  vertebra. 

The  body  was  so  brittle  that  it  was  useless  to  try  to  dissect  it 
in  this  condition.  Accordingly,  after  detaching  the  head,  it  was 
placed  into  the  usual  softening  solution  for  twenty-four  hours. 


NOTES  ON  TWO  EGYPTIAN  MUMMIES  131 

15.  When  the  body  was  taken  out  of  the  solution,  hardly  a  trace 
of  the  dorsal  vertebral  column  could  be  discovered.  All  that 
remained  of  the  vertebrae  consisted  of  some  small  crumbling  pieces 
of  bone,  though  several  intervertebral  discs  were  found,  which 
exhibited  no  sign  of  disease.  On  the  other  hand,  cervical  and 
lumbar  vertebrae,  sacrum  and  pelvis  were  normal. 

At  the  lower  end  of  the  dorsal  region,  there  was  a  hole  extending 
from  the  back  to  the  abdominal  cavity.  This  cavity  had  been 
plugged  from  the  abdominal  cavity  and  from  the  back  by  linen 
soaked  in  gum.  The  two  plugs  when  joined  together  looked  like 
an  hour-glass.  There  had  therefore  evidently  been  a  large  cavity 
which  had  been  filled  after  death  in  order  to  prevent  the  embalming 
material  from  escaping.  The  fluid,  gummy  material,  nevertheless, 
had  found  its  way  for  some  distance,  between  the  muscles  of  the 
back,  into  the  axillae  and  groins  on  both  sides. 

No  gum  whatever  discovered  in  the  limbs  or  in  the  mouth, 
though  it  had  found  its  way  into  the  pharynx  and  posterior  nares. 

The  body  had  been  bandaged  tightly  when  it  was  still  fairly  soft, 
as  the  marks  of  the  bandages  could  be  seen  on  several  parts  of  the 
thighs. 

16.  Head  contained  small  pieces  of  resin  and  stump  of  a  tooth, 
all  of  which  had  evidently  fallen  in  after  death.  Skull  otherwise 
empty,  except  near  the  foramen  magnum  where  pieces  of  membrane 
were  still  adherent.  Cribriform  plate  of  ethmoid  and  small  wing  of 
the  sphenoid  had  been  fractured  on  each  side  by  embalmers  when 
the  brain  was  taken  out  through  nostrils. 

Bony  and  cartilaginous  septa  of  nose  unhurt. 

No  trace  of  pits  for  Pacchionian  bodies  in  vault  of  skull. 

EXAMINATION   OF  TEETH 

Grinding  surface  of  teeth,  especially  of  molars,  much  worn. 

Wisdom  teeth  present. 

Lower  maxilla.  Alveoli  of  both  first  molars  completely  oblit- 
erated. 

Upper  maxilla.  Left:  third  molar,  alveolus  completely  oblit- 
erated; second  molar,  alveolus  partly  obliterated;  first  molar, 
laveolus  completely  obliterated.     Right:  second  and  third  molars, 


132         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

alveoli  completely  obliterated;   first  and  second  premolars,  alveoli 
completely  obliterated. 

HISTOLOGICAL  EXAMINATION 

Only  parts  examined  were  skin  of  abdomen,  back,  and  fingers, 
also  arteries  and  nerves.  These  were  placed  in  softening  solution, 
where  they  became  pliable,  showing  that  the  body  had  in  no  way 
been  carbonised.  Epidermic  layers  could  still  be  made  out  as 
flattened  cells,  and  the  general  structure  of  the  corium  was  fairly 
well  retained. 

No  sweat  glands  could  be  seen.  Muscular  fibres  were  teased 
out  with  caustic  potash  and  showed  the  striation  fairly  well. 
Arteries  of  the  limbs  showed  no  alterations.  In  the  nerves,  epineu- 
rium  and  endoneurium  were  perfect.  Medullary  sheath  made  out 
in  transverse  sections.     Axis  cylinders  absent. 

PATHOLOGICAL  EXAMINATION 

The  hands  showed  deformation  described  by  Professor  Bou- 
chard, and  which  is  generally  called  by  his  name  (Plate  XXXIII) . 

Attention  has  been  drawn  already  to  the  peculiar  deformity  of 
the  face,  simulating  left  facial  paralysis.  Perhaps  very  much 
importance  must  not  be  attached  to  this  nor  to  the  protrusion  of  the 
tongue,  as  such  an  appearance  may  possibly  have  been  caused  by 
manipulations  after  death.  Still,  we  must  say  that  it  is  the  only 
mummy  in  which  we  have  ever  observed  this  appearance. 

A  remarkable  point  is  the  almost  total  disappearance  of  the 
dorsal  vertebrae. 

Some  of  the  dorsal  vertebrae  were  noticed  lying  in  the  body 
cavity,  though  they  looked  strangely  altered.  We  regret  we  did 
not  endeavour  to  remove  them  before  placing  the  body  in  the 
macerating  solution,  as  it  is  now  impossible  to  know  why  they 
dissolved  almost  completely. 

As  the  lumbar  vertebrae,  the  ribs,  clavicles,  bones  of  the  arm, 
cervical  vertebrae,  treated  exactly  in  the  same  way,  did  not  show 
any  signs  of  dissolution,  we  conclude  that  extensive  pathological 
changes  may  have  existed  in  the  dorsal  vertebrae  and  rendered  them 
susceptible  to  the  dissolving  action  of  weak  carbonate  of  soda. 
Whatever  the  pathological  change  may  have  been,  it  did  not  extend 


NOTES  ON  TWO  EGYPTIAN  MUMMIES  133 

to  all  the  intervertebral  discs,  for  some  we  found  were  normal. 
Our  only  excuse  for  neglecting  to  remove  the  dorsal  vertebrae  is 
that  we  have  never  had  this  experience  before. 

The  articular  surface  of  the  knee-joints  was  jet-black,  although 
not  a  trace  of  foreign  material  could  be  discovered  with  the  micro- 
scope. 

Mr.  A.  Lucas  kindly  gave  us  the  following  notes  on  the  results 
of  the  chemical  examination  of  materials  removed  from  the  body. 

Bandages  near  pubis. — The  resinous-looking  material  on  the 
bandages  is  not  resin,  but  possibly  gum  altered  by  age  and 
exposure;  it  contains  a  small  amount  of  combined  soda,  also  sodium 
chloride  and  sulphate,  possibly  indicating  the  use  of  natron.  The 
results  of  the  analysis  are  as  follows : 

Per  Cent 

Soluble  in  petroleum  ether o.  70 

Soluble  in  absolute  alcohol 2 .  70 

Soluble  in  water  after  alcohol 40. 90 

Insoluble  organic  matter  (by  difference) 50 .  00 

f  soluble  in  water* 3 .  20 

Mineral  matter  <  .      ,  ,  ,    . 

{ insoluble  m  water 2 .  50 

100.00 

*  Sodium  salts. 

Bandages  with  white  spots. — The  bandages  contain  a  small 
amount  of  an  aromatic,  resinous  substance,  together  with  a  small 
amount  of  combined  soda  and  also  sodium  chloride  and  sulphate, 
possibly  indicating  the  use  of  natron. 

Gum  between  skin  and  muscles  of  back. — The  sample  is  not  a 
resin,  but  is  possibly  gum  altered  by  age  and  exposure;  it  contains 
a  small  amount  of  combined  soda,  also  sodium  chloride  and  sul- 
phate, possibly  indicating  the  use  of  natron.  The  results  of  the 
analysis  are  as  follows: 

Per  Cent 

Soluble  in  petroleum  ether trace 

Soluble  in  absolute  alcohol 1 .  60 

Soluble  in  water  after  alcohol 52. 30 

Insoluble  organic  matter  (by  difference) 36. 70 

.  f  soluble  in  water* s.oo 

Mineral  matter  <.,,,. 

( insoluble  in  water 4.40 

100.00 

*  Sodium  salts. 


134         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 


The  method  of  embalming  in  this  case  appears  to  have  been  as 
follows: 

An  incision  having  been  made  in  the  left  flank,  the  viscera  were 
removed,  and,  unfortunately,  their  ultimate  fate  is  unknown.  The 
body  was  then  probably  immersed  in  the  pickling  solution.  This 
solution  may  or  may  not  have  contained  natron,  as  the  amount 
found  was  small,  and  in  fact  the  only  evidence  we  have  that  a 
pickling  solution  was  used  is  that  the  nails  were  tied  to  the  fingers. 

During  these  manipulations  it  is  possible  that  a  large  hole  was 
made  in  the  back,  possibly  through  clumsiness  or  on  purpose.  It 
is  more  probable,  however,  that  owing  to  some  disease  (e.g.,  tuber- 
cular caries,  secondary  cancer,  bedsore,  etc).,  a  weak  point  existed 
in  that  situation  during  life,  and  that  a  careless  workman  greatly 
extended  this  defect. 

The  back  being  broken,  the  body  would  have  collapsed,  had  not 
a  stick  been  introduced  which  acted  as  an  artificial  backbone.  The 
cavity  was  plugged  with  coarse  bandages  and  the  body  treated  with 
thick  gum,  applied  very  hot  externally  and  internally;  the  excess  of 
hot  gum  being  allowed  to  escape  through  the  perineum,  which  was 
plugged  afterwards.  The  gum  was  then  allowed  to  set  almost 
hard  and  the  body  bandaged  in  the  manner  described  above. 

Such  mummies  more  or  less  artificially  built  up  are  probably  by 
no  means  rare,  and  several  such  instances  are  on  record  already. 

Maspero,  in  his  classical  work  (Momies  royales) ,  tells  us  that  the 
Princess  Sitamon  was  supposed  to  have  been  buried  in  a  small  coffin 
bearing  her  name.  The  mummy,  however,  actually  consisted  of  a 
thin  layer  of  bandages  containing  a  parcel  of  djerids  topped  by  a 
child's  cranium;  the  whole  measuring  about  i  metre  20  centimetres 
in  length. 

Not  infrequently  the  mummy  was  robbed  and  broken  up  by 
robbers,  who  made  up  an  artificial  mummy  and  substituted  it  for 
the  original.  This  was  the  case  with  the  mummy  of  the  princess 
Manshont-timihou  and  that  of  Prince  Siamon  (see  Maspero,  Momies 
royales,  pp.  544  and  538). 

The  body  of  the  princess  consisted  of  a  bit  of  yellow  coffin 
with  yellow  varnish,  the   handle  of   a   mirror   and   some   small 


NOTES  ON  TWO  EGYPTIAN  MUMMIES  135 

objects,  while  a  parcel  of  rags  simulated  the  head  and  another 
parcel  the  feet. 

The  mummy  of  Prince  Siamon  had  been  robbed  in  olden  times 
and  broken  into  pieces.  When  it  was  made  up  again,  no  care  was 
taken  to  reconstitute  the  skeleton,  and  the  bones  were  simply 
thrown  together  higgledy-piggledy  to  form  an  oblong  parcel. 

The  Museum  of  Lyons  (Lortet,  Faune  momifiee,  Fasc.  2,  p.  35) 
possesses  a  very  interesting  specimen  brought  back  by  M.  Chantre, 
which  is  composed  of  the  body  of  a  man  from  the  head  to  the  waist. 
The  pelvis  is  absent ;  the  thighs  are  replaced  by  branches  of  acacia 
bearing  at  their  extremities  small  female  legs,  of  which  the  flexor 
and  extensor  tendons  of  the  toes  "had  evidently  been  dissected  by 
a  long  maceration  in  the  water  of  the  river."  (?) 

This  process  of  substituting  part  of  the  body  for  the  whole 
extended  even  to  bodies  of  animals.  Lortet  (Faune  momifiee,  Fasc. 
2;  P-  53)  states:  "It  is  interesting  to  note  that  cats  like  ibis  were 
not  always  embalmed  whole.  One  has  seen  mummies  of  ibis  which 
contained  only  the  back  and  the  feet,  or  some  feathers." 

In  the  Archaeological  Survey  of  Nubia  (1907-8,  pp.  204-5)  Wood 
Jones  has  recorded  several  cases  where,  in  the  Ptolemaic  period, 
the  head  of  the  body  had  been  connected  with  the  trunk  by  means 
of  a  stick. 

In  the  case  of  a  child 
the  body  was  kept  intact  by  a  stick  which  passed  through  its  entire  length, 
for  the  child  had  been  spiked  by  a  stick  pushed  into  the  vagina,  thence  through 
the  abdomen  and  thorax,  into  the  cavity  of  the  skull.  The  lower  end  of  the 
stick  extended  down  below  the  knees,  and  no  attempt  had  been  made  even  to 
trim  its  rough  end.  The  outward  appearance  of  the  mummy,  however,  was 
quite  normal  and  aroused  no  suspicion  of  these  curious  manipulations. 

We  may  also  draw  attention  to  the  fact  that  although  we  were 
quite  convinced  that,  in  the  first  case,  the  black  substance  used  for 
mummification  was  bitumen,  yet  as  a  matter  of  fact  not  a  trace  of 
this  substance  was  found  by  chemical  analysis. 

MUMMY   NO.    2. 

To  all  outward  appearances,  this  mummy  was  exactly  like  the 
one  ju-t.  « 1  < ■  .'  li i j< ■< I .  The  following  arc  the  notes  taken  at  the 
examination  of  the  body. 


136         STUDIES  IN  THE  PALEOPATHOLOGY  OF  EGYPT 

NOTES   OF   EXAMINATION 

i.  After  few  remaining  narrow  outer  bandages  there  came: 

2.  Strips  of  linen  arranged  diagonally  across,  but  untidily  and 
without  any  definite  order. 

3.  A  broad  piece  of  linen  forming  a  shroud  covering  the  whole. 

4.  Beneath  this,  band  9  centimetres  in  width  running  along  one 
side  of  the  body,  over  head,  down  other  side  and  wrapped  several 
times  round  feet. 

5.  A  mass  of  rags  very  untidily  arranged  and  greatly  begrimed 
with  gum,  kept  in  place  by  several  long  bands  20  centimetres 
broad,  which  ran  over  head  and  feet  of  mummy  and  along  whole 
length. 

6.  Another  mass  of  rags  very  untidily  arranged,  held  in  position 
by  transverse  broad  bands  also  arranged  without  order.  In  the 
region  of  the  pelvis,  a  metacarpal  bone  was  found  lying  between 
these  rags. 

7.  The  rags  having  been  carefully  removed,  a  mass  of  bones  was 
found  lying  in  a  kind  of  crate  made  of  ribs  of  palm  leaves  (Plate 
XXXVII,  Figs.  9  and  10).  At  the  bottom  of  the  crate,  six  little 
sticks  placed  vertically  upwards  and  surrounded  by  masses  of 
bandages  represented  the  feet. 

The  bones,  being  greatly  begrimed  with  earth,  had  evidently 
been  buried  first  and  then  placed  inside  the  crate. 

The  two  tibiae  were  at  the  lower  extremity  of  the  crate.  Then 
came  the  two  femurs,  right  one  upside  down  and  on  left  side.  One 
fibula  lay  behind  the  femurs. 

Most  of  vertebrae  massed  together  in  pelvic  region,  and  majority 
of  the  bones  of  feet  were  in  right  abdominal  region,  and  had  been 
thrown  in  anyhow. 

Right  shoulder  formed  by  an  iliac  bone,  whereas  other  iliac  bone 
represented  the  front  of  the  chest.  One  scapula,  placed  upside 
down,  stood  for  other  shoulder.  Lower  end  of  the  sternum  was 
lying  transversely  across  the  chest,  the  manubrium  near  scapula  on 
left  side.  Some  vertebrae  and  sacrum  occupied  left  abdominal 
region. 

A  long  stick,  consisting  of  a  rib  of  palm  leaf,  had  been  passed 
through  the  atlas  vertebra  (which  was  still  hanging  on  the  stick) 


NOTES  ON  TWO  EGYPTIAN  MUMMIES  137 

and  the  foramen  magnum  into  the  head,  and  had  been  tied  by- 
bandages  to  lower  end  of  crate  (Plate  XXXVIII,  Fig.  n). 

No  traces  of  skin  or  organs  remained,  but  here  and  there  small 
remnants  of  tendons,  cartilages,  and  muscles  were  still  attached  to 
the  bones. 

Orbits  were  full  of  earth.  Lower  jaw  and  hyoid  bone  were  lying 
together  under  the  skull.  The  alveoli  of  the  teeth,  many  of  which 
had  fallen  out  after  death,  were  filled  with  earth.  Some  of  the  teeth 
were  lying  loose  behind  the  head,  but  after  much  searching,  we 
accounted  for  all  of  them. 

Crate  consisted  of  seven  ribs  of  palm  leaves,  tied  together 
at  the  top  and  bottom  by  fine  palm  fibres  (Plate  XXXVIII, 
Fig.  n). 

The  bones  belonged  to  a  young  man,  certainly  under  twenty-five 
years  of  age,  for  the  wisdom  teeth  had  not  emerged.  Nevertheless, 
many  of  the  bones  showed  the  typical  lesions  of  chronic  osteo- 
arthritis. 

REMARKS 

The  dismemberment  of  the  body  had  been  deliberately  done, 
though  not  by  violence,  as  there  were  no  signs  of  cuts  or  injuries. 

It  appears  to  us  certain  that  the  body  was  first  buried  in  soft, 
moist  earth,  until  all  the  soft  parts  had  disappeared,  and  that,  after- 
wards, the  bones  were  gathered  together  and  arranged  in  the  crate 
in  the  manner  described. 

We  do  not  think  that  this  was  the  work  of  robbers,  for  in  order 
to  spoil  the  body  thieves  would  hardly  have  taken  the  trouble  to 
bury  it  and  then  replace  the  bones  in  the  crate.  Where  thieves 
have  interfered,  the  work  is  rough  and  ready  and  evidently  done 
in  a  hurry.  In  this  case,  on  the  other  hand,  some  care  was  taken  to 
arrange  the  bones  so  that  in  outward  shape,  at  any  rate,  the  whole 
should  resemble  a  human  mummy. 

It  appears  to  us  far  more  probable  that  we  have  to  deal  with  a 
cheap  method  of  preparing  bodies  for  burials.  According  to  our 
theory,  those  who  could  not  or  would  not  afford  an  expensive  form 
of  embalming  had  the  body  buried,  disinterred,  and  then  rearranged 
in  the  form  of  a  mummy. 

Time  will  show  whether  this  theory  is  correct  or  not. 


138         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

DESCRIPTION  OF  PLATES  XXXII-XXXVUP 

(For  particulars  see  text) 

PLATE  XXXII 

Fig.  1 . — Mummy  unrolled. 

Fig.  2. — Shows  mass  of  linen  rags  packed  under  outer  shroud. 

Fig.  3. — Shows  method  of  tying  limbs  to  body. 

plate  xxxiii 
Fig.  4. — Hands  of  mummy.    The  nails  are  fastened  to  fingers  by  string. 

PLATE  xxxiv 

Fig.  5. — Shows  long  shroud  covering  the  body. 
Fig.  7. — Body  after  removing  all  bandages. 

plate  xxxv 
Fig.  6. — Shows  plug  of  bandages  closing  the  cavity  at  the  back. 

plate  xxxvi 
Fig.  8. — Body  opened,  showing  rib  of  palm  leaf  supporting  the  body. 

plate  xxxvii 
Figs.  9  and  10. — View  of  bones  lying  in  crate. 

plate  xxxviii 

Fig.  11. — Crate  with  long  stick  passing  through  the  foramen  magnum  into 
the  skull.    Near  the  skull,  the  atlas  vertebra  is  seen  hanging  from  the  stick. 

1  Figs.  1-8  from  first  mummy,  Figs.  9-1 1  from  second  body.     All  the  photographs 
were  taken  by  Dr.  Arnoldo  Rietti. 


PLATE  XXXII 


lit 

ifct 

-s^B     '"''Tssh^ 

i         ^^  ^a^B 

tU 

Fig.  3 


PLATE  XXXIII 


Fie.  4 


PLATE  XXXIV 


PLATE  XXXVI 


PLATE  XXXVIII 


ON  PATHOLOGICAL  LESIONS  FOUND  IN  COPTIC 
BODIES  (400-500  A.D.) 

{Journal  of  Pathology  and  Bacteriology,  Vol.  XVIII  [1913]) 

A  word  of  explanation  for  the  subject-matter  of  this  paper  is 
necessary. 

In  trying  to  express  clearly  the  object  of  the  studies  which  Dr. 
Fouquet,  Dr.  Elliot  Smith,  Dr.  Wood  Jones,  Mr.  Shattock,  Dr. 
Ferguson,  Dr.  Rietti,  and  I  have  published  during  the  last  few 
years,  I  found  no  word  exactly  suitable.  Hence,  I  coined  the  word 
"paleopathology."  Palaeontology  is  defined  as  "the  science  of 
extinct  forms  of  life":  by  paleopathology,  however,  I  do  not  mean 
the  science  of  extinct  diseases,  but  the  science  of  the  diseases  which 
can  be  demonstrated  in  human  and  animal  remains  of  ancient  times. 
I  did  not  adopt  this  term  without  consulting  several  Greek  friends, 
notably  that  excellent  scholar,  Dr.  Demetriades,  who  assured  me 
that  the  word  carried  the  meaning  which  I  attributed  to  it. 

The  Coptic  bodies  which  I  have  studied  were  given  to  me 
by  Professor  Breccia,  curator  of  the  Alexandria  Archaeological 
Museum,  and  came  from  Antinoe  in  Upper  Egypt.  They  dated 
from  the  fifth  to  the  sixth  centuries  after  Christ,  and  were  there- 
fore about  fourteen  to  fifteen  hundred  years  old. 

It  is  certain  that  most  of  these  people  were  Christians,  as  the 
shirts  in  which  they  were  dressed  were  decorated  with  embroideries 
typical  of  Christian  times,  and  a  beautiful  Coptic  cross  was  carved 
on  one  of  the  coffins. 

The  bodies  had  been  originally  enclosed  in  wooden  coffins  and 
buried  in  sand.  Some  years  ago  they  were  dug  up  and  enclosed  in 
rough  deal  coffins.  When  handed  over  to  me  for  examination, 
they  were  dressed  in  the  long  linen  shirts  in  which  they  had  been 
buried.  From  the  embroideries  adorning  these  garments  I  con- 
1  luded  that  the  people  had  belonged  to  a  wealthy  class  of  the 
community.1 

derii    ,  now  cleaned  and  lool  ing  almost  new,  are  deposited  in  the 
Alexandria  Museum. 

139 


140         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Remains  of  strong  leather  boots  were  found  on  some  of  them. 
In  one  case  the  boots  were  well  preserved  and  reached  almost  to  the 
knee.  The  point  is  interesting,  as  some  lesions  discovered  in  the 
phalanges  (Plate  XLIII,  Figs.  22  and  23)  might  be  attributed,  with 
some  probability,  to  the  wearing  of  tight  footgear. 

These  bodies  differed  considerably  from  the  mummies  of  preced- 
ing periods.  Never  having  been  opened  by  the  embalmer,  the 
organs  were  in  situ,  and  they  contained  no  resin,  gum,  or  any 
materials  (such  as  mud,  sand,  rags,  sawdust,  etc.)  generally  used 
in  Old  Egypt  for  packing  the  body,  after  removal  of  the  organs. 
The  only  preservative  found,  and  this  in  two  cases  only,  was  com- 
mon salt.  In  one,  a  lump  of  salt,  the  size  of  a  man's  fist  was  lying 
on  the  abdomen,  and  Mr.  Lucas,  of  the  Survey  Laboratory  in  Cairo, 
pronounced  it  to  be  sodium  chloride.  In  another,  small  lumps  of 
the  same  material  had  been  scattered  over  the  abdomen  and  chest. 

There  was  nothing  to  show  that  the  body  had  been  macerated, 
for  the  skin,  where  no  insects  had  penetrated,  was  untouched  and 
the  epidermis  readily  demonstrated.  In  one  body,  however,  there 
was  in  the  lumbar  region  a  distinct  swelling,  and  when  opened  a 
large  abscess  cavity  was  revealed.  The  contents  to  the  naked  eye 
were  grey,  granular,  and  easily  removed.  No  cause  for  this  abscess 
was  discovered  (Plate  XXXIX,  Fig.  2a). 

The  nails,  which  had  evidently  been  cleaned  and  cut  after  death, 
were  not  tied  to  the  fingers.  The  hair  of  the  head  was  long  (Plate 
XXXIX,  Fig.  1),  both  in  males  and  females,  and  all  the  adult  men 
had  yellowish-red  beards.1 

The  penis  had  suffered  considerable  damage  during  the  1,400 
years  which  had  elapsed  since  death,  so  that,  in  most  cases,  I  could 
not  make  sure  whether  it  had  been  circumcised  or  not.  In  one 
case  it  had  certainly  not  been  circumcised. 

During  the  process  of  desiccation,  the  hands  and  feet  had  become 
greatly  contorted  and  were  often  typically  claw-shaped.  The  bones 
of  the  hands  and  feet,  however,  were  found  normal,  except  for  the 
lesions  to  be  described  further  on. 

The  bodies,  therefore,  could  not  be  called  mummies  in  the  sense 
in  which  that  word  is  generally  used.     They  had  undergone  no 

1 1  could  not  make  sure  whether  this  red  colour  was  due  to  henna  or  not. 


PATHOLOGICAL  LESIONS  IN  COPTIC  BODIES  141 

artificial  process  except  that,  at  one  time,  they  had  been  covered, 
more  or  less  extensively,  with  salt.  The  real  preservative  had  been 
the  dry,  Egyptian  sand. 

Unfortunately  for  our  purpose,  the  hot,  moist  climate  of  Alex- 
andria had  produced  evil  effects  on  these  remains.  Innumerable 
moulds  had  grown  during  the  last  two  years  in  the  acid  tissues,  and, 
occasionally,  the  internal  organs  had  become  converted  into  a 
sticky,  glue-like,  black  mass  with  which  nothing  could  be  done;  in 
others,  however,  the  organs  were  in  a  very  fair  state  of  preservation. 
Crystals  of  fatty  acids  often  covered  the  internal  parts,  especially 
the  liver. 

The  brain  was  always  present,  not  having  been  tampered  with 
in  ancient  times.  As  a  rule,  the  dura  mater  (Plate  XLII,  Fig.  9) 
was  still  adherent  to  the  cranium;  the  falx  cerebri  (Plate  XLII, 
Fig.  10)  was  perfect  and  the  shrivelled  brain  lay  at  the  back  of  the 
head  (Plate  XLII,  Fig.  9).  The  lobes  of  the  brain  and  some  of  the 
convolutions  were  recognisable,  whereas  the  cerebellum  was  repre- 
sented by  a  crumbling  yellowish  mass  of  no  particular  structure. 
The  medulla  oblongata  and  the  spinal  cord  had  completely  disap- 
peared.    The  spinal  dura  mater  was  perfect. 

The  lungs  (Plate  XL,  Fig.  3)  usually  lay  flat  at  the  back  of  the 
pleural  cavity.  They  were  jet-black,  not  thicker  than  a  stout  piece 
of  cardboard,  and  traces  of  adhesions  were  frequently  found. 
Sometimes  these  organs  were  retracted  and  pressed  against  the  side 
of  the  chest  wall;  they  had  shrunk  to  a  length  of  about  6  inches 
and  measured  not  more  than  half  an  inch  in  thickness.  Neverthe- 
less, the  bronchi  were  recognisable  with  the  microscope,  and  the 
alveolar  structure  of  the  organ  could  be  made  out.  The  alveoli, 
of  course,  were  less  than  one-fifth  the  size  of  normal,  and  the  whole 
microscopical  structure  had  what  might  be  described  as  a  Lilliputian 
appearance.  The  lymphatic  glands  of  the  chest  could  not  be 
found  as  a  rule. 

The  heart  (Plate  XL,  Fig.  3)  was  usually  represented  by  a  tube- 
like, yellow,  crumbling  mass.  The  striated  fibres  were  easily 
demonstrated,  and  in  some  cases  even  the  valves  were  seen.  On 
the  whole,  however,  this  viscus  was  badly  preserved,  and  its 
examination  disappointing. 


142         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  whole  mass  of  the  intestines,  shrivelled  up  to  an  almost 
incredible  degree,  often  came  away  with  the  abdominal  wall.  By 
appropriate  treatment  fairly  large  pieces  of  intestine  (12  inches  in 
length)  were  obtained,  but  in  spite  of  every  possible  care  I  seldom 
demonstrated  greater  lengths  of  the  intestinal  canal.  Under  the 
microscope  the  coats  of  the  intestine  were  visible ;  and  though  the 
columnar  epithelium  lining  of  the  mucous  membrane  had  disap- 
peared, the  glands  were  in  a  remarkably  fine  state  of  preservation, 
except  that  the  epithelium  cells  had  run  together.  With  haematoxy- 
lin  the  epithelium  cells  stained  yellow,  and  the  connective  tissue 
was  of  a  beautiful  blue. 

A  remarkable  fact  was  that  in  three  bodies  the  rectum  was 
enormously  distended  by  a  brown  mass,  consisting  almost  entirely 
of  vegetable  fibres,  which  the  botanist  to  whom  I  showed  them  and 
I  were  unable  to  identify.  This  vegetable  material  was  mixed  with 
a  brownish,  thick  substance,  probably  faeces,  which  dissolved  easily 
in  water,  carbonate  of  soda,  and  alcohol.  Prolapse  of  the  rectum 
was  seen  in  two  cases  (Plate  XXXIX,  Fig.  1) .  I  have  found  similar 
masses  of  vegetable  fibres  in  a  dried  body  of  the  Xllth  Dynasty, 
and  in  a  boy  of  the  Greek  period  (Plate  XL,  Fig.  4).  In  the  latter, 
the  intestine  formed  a  large  lump  in  the  left  iliac  fossa,  the  sigmoid 
flexure  being  enormously  distended.  I  cannot  help  thinking  that 
the  vegetable  matter  had  been  introduced  either  by  mouth  or  anus 
during  the  last  illness  for  some  therapeutic  purpose. 

The  liver  (Plate  XLI,  Fig.  8),  dried  up  almost  into  the  shape  of 
a  tube,  was  in  position  in  the  right  flank.  The  gall  bladder  was 
unrecognisable.  The  liver  measured  about  16-17  cm-  in  length, 
8  cm.  in  thickness,  and  weighed  180  gm.  on  an  average  Its  sub- 
stance, for  the  first  few  millimetres  near  the  surface,  was  rather 
soft,  black,  and  sticky,  and  became  hard,  crumbling,  and  of  a  dirty- 
yellow  colour  in  the  deeper  regions.  The  cut  surface  was  more  or 
less  granular,  and  when  exposed  to  air  soon  became  black,  soft,  and 
sticky.  In  an  appropriate  solution,  small  pieces,  though  they  never 
swelled  up  to  any  extent,  softened  considerably  and  after  a  time 
became  converted  into  a  yellowish,  sticky,  gummy  mass,  which, 
when  hardened  in  absolute  alcohol,  could  be  cut  in  the  usual 
manner  with  the  microtome. 


PATHOLOGICAL  LESIONS  IN  COPTIC  BODIES  143 

The  microscopical  appearance  varied  considerably.  In  some 
cases  long  strands  of  homogeneous  material  only  were  seen,  in  which 
no  structure  could  be  made  out.  Sometimes,  on  the  contrary,  the 
cells  were  distinct.  They  measured  about  one-third  of  their  usual 
size,  were  round  or  irregular  in  shape,  and  did  not  stain  except  with 
powerful  aniline  stains.  Not  unfrequently  the  nuclei  were  distinct 
in  the  centre  of  the  cells  and  looked  like  vacuoles.  Very  often  the 
lobular  arrangement  of  the  organ  was  preserved  even  when  the 
connective  tissue,  smaller  blood  vessels,  and  bile  ducts  had  com- 
pletely disappeared.  Only  the  larger  vessels  and  the  liver  cells 
were  left,  and  they,  together  with  the  thicker  strands  of  connective 
tissue,  stained  deeply  with  haematoxylin. 

The  spleen  (Plate  XLI,  Fig.  5),  intensely  dark  in  colour,  was 
not  always  found,  in  spite  of  laborious  searching.  It  measured  as 
a  rule  6  cm.  in  length,  4  cm.  in  breadth,  and  2  cm.  in  thickness. 
Microscopically  very  little  except  strands  of  connective  tissue 
could  be  recognised. 

The  kidneys  (Plate  XLI,  Fig.  7)  were  flat,  1  cm.  thick,  10  cm. 
long,  3  cm.  broad,  and  weighed  10  gm.  each.  They  were  dis- 
covered easily.  Microscopically  the  tubuli,  connective  tissue,  and 
glomeruli  were  demonstrable,  though  of  course  they  were  greatly 
altered. 

The  ovaries,  uterus,  and  suprarenal  capsules  were  not  seen,  nor 
was  it  possible,  as  a  rule,  to  separate  the  bladder  from  the  sur- 
rounding connective  tissue. 

The  testicles  were  in  a  very  bad  state  of  preservation,  all  the 
internal  structure,  except  the  thick  connective  tissue  septa,  having 
disappeared. 

The  arteries,  nerves,  and  muscles  were  quite  distinct.  In  two 
aortae  well-marked  calcareous  plates  were  found. 

A  point  to  be  remembered  is  that  all  the  histological  elements 
had  shrunk  greatly;  and  it  is  impossible  to  lay  down  a  rule  as  to 
the  amount  of  this  shrinkage.  Usually  they  were  about  one-third, 
and  never  more  than  half  their  natural  size,  so  that  it  was  necessary 
to  work  with  much  higher  powers  of  the  microscope  than  usual. 
The  sections,  in  spite  of  numerous  washings,  always  remained 
stained  brownish  yellow. 


144         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  bones,  though  hard  and  well  preserved,  stood  maceration 
rather  badly,  and  care  had  to  be  taken  not  to  leave  them  in  water 
too  long.  The  cartilages,  always  stained  intensely  black,  were 
perfect,  and  after  maceration  in  dilute  caustic  potash  could  be 
removed  whole. 

Altogether  sixteen  Coptic  bodies  were  examined,  namely,  six 
women  and  ten  adult  men.  Of  the  six  women,  two  were  young 
girls  certainly  not  more  than  sixteen  years  old.  They  showed  no 
pathological  lesions. 

LESIONS    OF   THE   TEETH 

The  general  appearance  of  the  teeth  did  not  suggest  that  much 
care  had  been  taken  of  .them,  as  they  were  often  yellow  and  covered 
with  tartar.  In  one  case,  indeed,  the  deposit  of  tartar  was  truly 
enormous,  being  at  least  2  mm.  thick.  Attrition  was  not  marked, 
and  the  crowns  contrasted  with  those  of  predynastic  skulls  of  Egypt, 
which  are  often  ground  down  to  the  level  of  the  gums.  In  most 
cases,  however,  serious  lesions  of  the  teeth  and  alveoli  were  present, 
and  the  life  of  some  of  these  people  must  have  been  one  of  perfect 
misery,  owing  to  the  state  of  their  mouths. 

Description  of  Dental  Lesions  Found 

i.    adult  man,  probably  about  forty-five  years  old. 

Teeth  missing.1 — Maxillae:  Right  first  molar  and  second  premolar;  left 
first  molar.  Mandible:  Right  second  premolar  and  first  molar;  left  first 
molar.  Teeth  not  much  worn,  with  exception  of  left  third  lower  molar.  Lower 
left  second  premolar  carious  on  posterior  approximate  side. 

n.    adult,  but  not  old. — Basilar  suture  ossified,  other  sutures  still  open. 

Teeth  missing. — Maxillae:  Left  first  molar  and  probably  first  premolar 
also.     Mandible:  Third  molar. 

Other  lesions  of  teeth. — Maxillae:  First  right  molar  extensively  carious.  In 
connection  with  the  anterior  fang  (Plate  XLIII,  Fig.  17  A),  an  abscess  had 
formed  which  had  perforated  through  palate  into  nasal  cavity.  Track  fol- 
lowed by  pus  evident,  and  opening  into  the  nasal  cavity  is  nearly  the  size  of 
threepenny  piece.  No  perforation  into  antrum.  Mandible:  Whole  outer 
wall  of  alveolus  of  right  first  molar  has  been  worn  away,  evidently  by  suppura- 
tion (Plate  XLIII,  Fig.  25).      Tooth  itself  healthy,  though  crown  somewhat 

1  As  teeth  often  drop  out  after  death,  I  consider  as  missing  only  those  teeth  the 
alveoli  of  which  are  completely  or  almost  completely  absorbed. 


PATHOLOGICAL  LESIONS  IN  COPTIC  BODIES  145 

worn.  Second  molar  has  one  fang  only,  deeply  carious.  Judging  from  size 
of  the  alveolus,  I  conclude  that  there  had  been  some  ulceration  round  that 
fang  also. 

The  dental  disease  was  of  old  standing,  and  the  third  molar  had  fallen  out 
or  been  removed  some  time  before  death.  The  floor  of  the  alveolus  was 
partially  filled  up  with  bone.  The  top  of  it,  on  the  other  hand,  was  nearly 
1.2  cm.  wide,  and  in  all  probability  there  had  been  an  abscess  round  that 
tooth  also.  The  suppuration  had  extended  backward  along  the  outer  side  of 
the  gums  round  the  second  and  third  molar  teeth  in  the  upper  maxilla,  as  the 
bone  in  that  situation  is  singularly  smooth,  and  its  perfectly  rounded  edge  is  in 
sharp  contrast  with  the  rugged  edge  in  front.  Moreover,  the  fangs  of  the 
teeth  are  exposed  through  their  whole  length  owing  to  the  absorption  of  the 
alveolar  walls. 

This  man  suffered  also  from  chronic  nasal  disease,  from  arthritis  in  the 
glenoid  fossa,  from  periostitis  of  the  great  trochanter  of  the  femur,  and  chronic 
spondylitis.  Racked  as  he  must  have  been  with  dental  agony,  afflicted  with  a 
chronic  nasal  discharge,  and  stiff  with  pain  in  his  hip  and  spine,  his  life  must 
have  been  well-nigh  unbearable. 

m.      ADULT  WOMAN,   PROBABLY  ABOUT  TWENTY-SIX    YEARS     OLD. — Lower 

third  molars  present,  whereas  upper  had  not  emerged. 

Teeth  missing. — Maxillae:  Normal.  Mandible:  Right  first  molar;  left 
first  and  third  molars. 

Other  lesions. — Extensive  caries  of  posterior  part  of  second  left  molar 
extending  almost  to  fang.  Right  second  and  third  molars  extensively  carious 
where  they  touch.     Crowns  but  little  worn. 

IV.   MAN,  ADULT  BUT  NOT  AGED,  PROBABLY  ABOUT  THIRTY  YEARS  OLD. 

Teeth  missing. — Maxillae:  All  right  premolars  and  molars.  Left  second 
premolar  and  third  molar.  Mandible:  Right  second  molar;  left  molars  and 
premolars. 

Other  lesions. — Maxillae:  Second  right  incisor,  carious.  Region  occupied 
by  left  first  and  second  molars  hollowed  out  into  a  cavity  with  deeply  pitted 
floor,  measuring  1.5  cm.  from  before  backwards,  and  1.2  cm.  from  side  to  side. 
Outer  wall  of  the  alveolus  of  the  first  molar  completely  gone.  Evidently 
there  had  been  extensive  suppuration  round  the  first  and  second  molars, 
possibly  beginning  in  the  teeth  themselves.  These  had  either  fallen  out  or 
been  removed  some  time  before  death.  It  is  highly  probable  also  that  there 
had  been  an  abscess  round  right  canine. 

v.    young  woman,  whose  third  molars  had  not  emerged  yet. 

Teeth  missing. — Mandible:  Second  left  premolar;  first  right  molar,  carious; 
right  middle  turbinated  bone  twice  the  size  of  the  left. 

vi.  very  old  woman. — Upper  jaw  completely  smashed  after  death,  prob- 
ably at  the  time  body  was  taken  out  of  the  grave,  so  no  examination  of  it  was 
possible.  Mandible:  All  the  teeth  with  exception  of  four  incisors  had  dis- 
appeared long  ago,  and  alveoli  had  been  completely  absorbed. 


146         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

vn.  man  about  rORTY-rrvE  years  OLD. — Uncircumcised.  All  teeth  per- 
fect, slightly  worn. 

VLn.     MAN  ADVANCED  IN  AGE. 

Teeth  missing. — Maxillae  (right  side) :  All  premolars,  first  molar,  third 
molar,  second  molar  present.  There  had  been  considerable  inflammation 
round  it,  so  that  alveolus  is  almost  completely  absorbed.  Left  side:  First 
premolar,  second  premolar,  second  and  third  molars.  First  molar  shows  the 
same  alteration  as  the  second  molar  on  other  side.  Mandible:  Left  molars 
and  premolars;  right  second  and  third  molars.  There  is  some  attrition  of 
all  the  teeth. 

rx.  old  woman. — All  teeth  in  upper  jaw  missing  (Plate  XLIII,  Fig.  15). 
Mandible  (right) :  Molars,  premolars,  canine,  and  one  incisor.  Left :  Central 
incisor,  canine,  second  premolar,  and  all  molars. 

ALVEOLAR  AND   OTHER   LESIONS 

Perhaps  the  most  striking  changes  are  the  signs  of  periodontitis 
and  suppuration  round  the  roots  of  the  teeth,  which  were  present  in 
a  large  number  of  skulls. 

Let  us  examine,  for  instance,  Plate  XLIII,  Fig.  25,  and  Plate 
XLIII,  Fig.  17,  which  come  from  the  same  body.  Though  the 
teeth  are  regularly  planted,  the  fangs  throughout  their  whole 
length  are  almost  bare.  This  exposure  is  due  to  the  absorption  of 
the  wall  of  the  alveoli;  a  change  generally  most  marked  on  the 
labial  border  of  the  teeth.  In  Plate  XLIII,  Fig.  25,  for  instance, 
it  is  evident  that  suppuration  had  existed  round  the  molar  teeth, 
which  were  finally  contained  in  a  smooth-walled  cavity,  the  walls 
of  which  had  been  completely  absorbed.  Further,  this  process  of 
absorption,  though  less  complete,  has  proceeded  along  the  alveolar 
borders  of  the  upper  maxillae  and  mandible,  leaving  the  teeth  bare 
and  for  the  most  part  very  loose.  In  my  opinion,  we  are  here  in 
the  presence  of  the  pathological  lesions  produced  by  suppurating 
disease  of  the  alveoli  or  pyorrhoea  alveolaris. 

Another  mandible  is  very  interesting  from  this  point  of  view 
(Plate  XLIII,  Fig.  18).  At  (a)  the  alveolus  has  been  completely 
absorbed,  a  thin  bridge  of  bone  superiorly  being  all  that  remains  of 
it.  At  (c)  the  bony  alveolus  has  almost  disappeared,  only  the  thin- 
nest possible  layer  of  bone  remaining.  The  pus  had  evidently 
burrowed  into  the  deeper  parts  of  the  mandible.  The  alveolus 
itself  is  of  normal  size,  and  the  tooth  must  have  dropped  out  either 


PATHOLOGICAL  LESIONS. IN  COPTIC  BODIES  147 

just  before,  or  possibly  after,  death.  In  the  neighbouring  teeth  the 
same  process  had  been  going  on,  for  the  fangs  are  partly  bare,  and 
at  (b)  a  sinus  has  been  formed.  Without  doubt  that  tooth  was  on 
the  point  of  dropping  out.  It  is  very  probable,  if  not  absolutely 
certain,  that  the  loss  of  the  other  teeth  was  due  to  this  process  also. 

The  upper  jaws  of  the  same  skull  are  completely  edentulous, 
and  has  been  so  for  some  time  before  death,  for  the  alveoli  have 
been  absorbed  so  completely  that  not  a  trace  of  them  is  left.  The 
suppurating  process,  therefore,  had  attacked  the  whole  mouth,  and 
had  lasted  for  years  before  the  patient  finally  succumbed. 

In  another  skull  one  of  the  teeth  was  on  the  point  of  being  shed, 
one  fang  being  completely,  and  the  other  almost  completely,  bare, 
so  that  the  tooth  was  fixed  to  the  skull  by  one  fang  only  and  by  the 
centre  of  the  tooth  between  the  fangs  (Plate  XLIV,  Fig.  29). 

As  a  rule,  the  teeth  in  the  neighbourhood  were  perfectly  sound, 
and  not  carious.  In  a  few  cases,  however,  a  certain  amount  of 
odontitis  had  taken  place  and  calculi  had  formed  on  the  outer 
surface  of  the  teeth.  Sometimes,  on  the  contrary,  absorption  of 
the  tooth  round  the  neck  had  taken  place  (Plate  XLIII,  Fig.  18). 

The  alveoli  were  gradually  absorbed,  and  this  absorption  ap- 
pears to  have  started  from  the  bottom  and  gradually  worked  its 
way  towards  the  neck  of  the  tooth,  so  that  after  a  time,  in  the  molar 
region  for  instance,  the  fangs  were  laid  completely  bare,  and  the 
teeth  were  fixed  not  by  the  fangs  at  all,  but  by  the  centre  between 
the  fangs. 

Altogether,  therefore,  the  disease  was  characterised  in  Coptic 
times  as  it  is  now,  by  (1)  loosening  of  the  teeth;  (2)  absorption  of 
the  alveoli;   (3)  formation  of  fistulae. 

Transverse  striation  of  the  teeth  was  very  evident  in  one  person 
(Plate  XLIII,  Fig.  20).      The  cause  of  it  could  not  be  ascertained. 

OSSEOUS  LESIONS 
I.  ADULT  MAN,  BUT  NOT  AGED,  PROBABLY  ABOUT  THIRTY  YEARS  OLD. 

Spondylitis  Umiled  to  the  first  five  cervical  vertebrae. — Atlas:  Slight  thickening 
of  bone  on  the  anterior  arch  cavity  for  odontoid  process.  Axis:  Normal, 
except  that  top  of  odontoid  process  is  covered  by  a  little  cap  of  new  bone, 
measuring  3X3  mm.  Third  cervical  vertebra:  Upper  surface  normal.  Left 
inferior  articular  surface  slightly  enlarged;    right  articular  surface  greatly 


148         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

enlarged,  measuring  i. 5X1.3  cm.  Deposit  of  new  bone  all  round  the  edge, 
and  surface  has  a  worm-eaten  appearance. 

Right  upper  articulating  surface  and  left  lower  articulating  surface  of  the 
fourth  cervical  vertebra  and  corresponding  superior  articulating  surface  of  the 
fifth  greatly  enlarged,  with  a  worm-eaten  appearance. 

Lower  articulating  surface  of  the  fifth  cervical  vertebra  and  rest  of  the 
vertebral  column  normal. 

Although  the  characteristic  lesions  of  spondylitis  are  in  this  case  rather 
slight,  and  limited  to  one  side  of  the  cervical  part  of  the  vertebral  column, 
the  man  must  have  had  a  very  stiff  neck,  causing  great  limitation  of 
movement. 

Arthritic  and  other  lesions  in  the  same  person. — This  person  is  one  in  whom 
very  severe  dental  disease  was  present  (II).  He  was  an  adult,  but  by  no 
means  an  old  man. 

Glenoid  fossae:  Anterior  part  of  the  glenoid  fossa  is  much  thickened  and 
partly  eburnated.  On  right  side  there  is  considerable  thickening  of  bone, 
forming  an  irregular  patch,  measuring  2X1.2  cm.,  with  a  thickness  of  0.2  cm. 
It  extends  posteriorly  almost  to  bottom  of  the  fossa.  Condyles  of  mandible 
are  normal. 

Pathological  changes  in  vertebral  column  merely  consist  in  some  over- 
lipping  of  anterior  inferior  border  of  the  second  and  the  anterior  superior 
border  of  the  third  cervical  vertebrae.  Similar  changes  are  seen  in  sixth  and 
seventh  cervical  vertebrae,  in  dorsal  vertebrae  from  the  seventh  to  the  twelfth, 
and  in  lumbar  vertebrae  from  first  to  fourth.  Disease  is  most  marked  in 
dorsal  region,  where  new  bone  forms  a  thick  irregular  festoon  round  anterior 
border.     Last  lumbar  vertebrae,  sacrum,  and  coccyx  normal. 

Pelvis  shows  no  change,  except  for  some  distinct  thickening  round  lower 
border  of  acetabulum. 

Right  nostril  of  the  same  mummy  shows  a  curious  appearance  (Plate  XLIII, 
Fig.  12).  The  middle  turbinated  bone  on  that  side  is  conspicuously  swollen, 
its  free  extremity  being  about  four  times  as  thick  as  that  of  its  fellow.  Swelling 
gradually  tapers  towards  the  attached  border  and  occupies  only  anterior  two- 
thirds  of  the  bone,  posterior  third  being  practically  normal. 

This  swelling  had  deflected  the  bony  nasal  septum  very  markedly  to  the 
left,  and  this  is  also  perforated  by  numerous  small  holes,  which,  however,  may 
have  been  formed  post  mortem. 

Left  middle  turbinated  bone  had  a  very  ragged  edge,  but  is  not  noticeably 
swollen.    Both  inferior  turbinated  bones  are  practically  normal. 

Left  femur:  Thick  mass  of  new  bone  fills  up  cavity  for  the  ligamentum 
teres  almost  entirely,  and  projects  over  borders  of  cavity  especially  on  the 
inner  side.  New  bone  measures  2.5X1.5  cm.  (Plate  XLIV,  Fig.  30).  Great 
trochanter  is  covered  by  a  somewhat  thick  deposit  of  rough  new  bone.  Lower 
end  of  femur  would  be  normal  were  it  not  for  a  patch  of  spongy  new  bone 
about  1  mm.  in  thickness  and  the  size  of  a  threepenny  bit  on  the  lower  and 


PATHOLOGICAL  LESIONS  IN  COPTIC  BODIES  149 

inner  surface  of  the  articulation,  and  some  thickening  on  inner  and  outer 
borders  of  condyles. 

The  right  femur  (Plate  XLIV,  Fig.  30)  shows  similar  changes,  especially  in 
cavity  of  ligamentum  teres.  New  bone  in  this  position  measures  2  cm.  in  its 
longest  and  1.5  cm.  in  its  broadest  diameter.  There  is  some  slight  thickening 
round  the  edge  of  the  lower  end  of  the  femur.  A  distinct  rough-fitted  groove 
separates  the  new  bone  from  the  old,  and  the  whole  gives  the  impression  of  a 
chronic  process.  On  the  other  side  there  is  a  similar  mass  2  cm.  long,  1  cm. 
broad,  and  4  mm.  thick  on  the  upper  border  near  the  tip,  which  is  somewhat 
rough  though  otherwise  normal. 

n.      VERY  MUSCULAR   MAN. 

Spondylitis  deformans  (IV). — All  insertions  of  muscles  extremely  promi- 
nent. The  ensiform  cartilage  shows  a  curious  defect  in  ossification  (Plate 
XLIII,  Fig.  13). 

Cervical  vertebrae,  atlas:  Formation  of  new  bone  round  superior  border 
of  notch,  so  that  top  of  the  odontoid  process  is  overlapped  by  bone  growing 
from  atlas. 

Lower  articular  facets  of  third  vertebra  greatly  enlarged,  especially  on  right 
side,  where  they  are  rough  and  irregular,  with  a  thin  layer  of  new  bone  on  inner 
border.  Upper  articular  facets  of  fourth  cervical  correspondingly  enlarged, 
especially  right,  which  measures  2  cm.,  from  above  downwards.  All  other 
cervical  vertebrae  have  bifid  spinous  processes,  though  otherwise  normal. 

Third  dorsal  vertebra  has  a  strong  anterior  median  ridge  of  bone  projecting 
for  about  1.2  cm.,  corresponding  to  a  similar  ridge  on  fourth. 

Similar  lesions  on  the  sixth,  seventh,  eighth,  and  ninth  dorsal  vertebrae. 
Lesions  specially  marked  on  eighth  and  ninth  dorsal  vertebrae,  where  the 
corresponding  ridges  form  a  lateral  prolongation,  1  cm.  broad  at  the  base,  and 
which  projects  for  1.2  cm.  externally. 

Lesions  of  vertebral  column,  phalanges,  fibula,  and  patellae  (Til). — Marked 
overlipping  of  anterior  borders  of  bodies  of  twelfth  vertebrae  and  all  lumbar 
vertebrae.  • 

Terminal  phalanges  of  feet  and  hands  (Plate  XLIII,  Figs.  21,  22,  and  23) 
rough  and  thickened  at  proximal  and  distal  ends,  especially  at  point  of  insertion 
of  great  flexor  muscles,  and  one  has  the  impression  that  this  person  suffered 
from  chronic  synovitis.  In  both  great  toes  (Plate  XLIII,  Figs.  22  and  23)  the 
point  of  insertion  of  the  flexor  longus  hallucis  is  greatly  deepened  and  sur- 
rounded by  a  ridge  of  strong  new  bone  (Plate  XLIII,  Figs.  22,  23  A).  More- 
over, the  proximal  ends  of  both  halluces  present  marked  exostoses  (Plate  XLIII, 
Figs.  22  and  23).  The  distal  ends  of  all  the  phalanges  of  hands  and  feet  are 
exceedingly  rough,  as  if  they  had  been  worn  away  by  prolonged  inflammation. 

Scapulae:  A  mass  of  strong  new  bone  has  formed  at  the  tip  and  upper 
border  of  the  right  acromion  (Plate  XLIV,  Fig.  28).  This  extends  for  a  length 
of  3  cm.  and  has  an  irregular  upper  border  with  a  maximum  width  of  1.3  cm. 

Fibula:  Ossification  of  lateral  ligaments  (Plate  XLIII,  Fig.  11). 


ISO 


STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 


Patellae:  Ossification  of  lateral  ligaments. 

Lesions  of  phalanges  and  localised  spondylitis  deformans  {XII). — Terminal 
phalanges  of  both  big  toes  show  same  changes  as  the  preceding  case.  Eleventh 
and  twelfth  dorsal  vertebrae  show  prolongation  of  bone  on  anterior  border = 
localised  spondylitis  deformans. 

Moreover,  upper  articular  surface  for  rib  of  twelfth  dorsal  (Plate  XLIII, 
Fig.  19  A)  enormously  enlarged,  white,  ivory-like,  corresponding  to  similar 
facet  on  rib  (Plate  XLIII,  Fig.  16  A). 

III.      MALE. 

Exostosis  of  pelvis  and  other  lesions  (VIII). — Skull:  All  sutures  well 
advanced  in  ossification. 

Pelvis:  Plate  XLIII,  Fig.  24,  and  Plate  XLIV,  Fig.  27,  give  very  good 
pictures  of  a  remarkable  exostosis  of  that  bone.  The  dimensions  of  this 
exostosis  are  as  follows:  Length=5cm.;  thickness  at  tip  =2. 2 5  cm.;  depth 
at  5=  2  cm.;  depth  at  A=o.$  cm.;  base=4cm.  Exostosis  is  smooth,  though 
deeply  grooved  at  B  and  C,  as  if  by  blood  vessels.  There  are  no  signs  of 
inflammation  in  neighbouring  bones,  and  symphysis  is  quite  normal. 

Last  lumbar  vertebra  shows  signs  of  inflammation  (Plate  XLIV,  Fig. 
26  A),  and  there  is  some  slight  thickening  round  the  anatomical  necks  in  the 
humeri. 

On  left  fibula  there  is  a  sharp  transverse  cut,  about  1  cm.  long  and  less 
than  1  cm.  deep.  No  scar  of  skin  noticeable,  but  this  may  be  due  to  the  very 
bad  state  of  the  teguments. 

Injuries. — The  only  injuries  discovered  were  the  transverse  cut  on  the 
fibula,  mentioned  above,  and  a  healed  fractured  rib  shown  in  Plate  XLIII, 
Fig.  14. 

fcESIONS   OF    SOFT   PARTS 

Hypertrophy  of  spleen. — In  order  to  ascertain  whether  the  organs 
were  enlarged  or   the  reverse,  their  average   weight  had  to  be 


Weight 

Length 

Breadth 

Coptic 

Present  Day 

Coptic 

Present  Day 

Coptic 

gm. 

1S0 
12 
10 

gm. 
1,609 

171 
140 

cm. 

165 

6 

10 

cm. 

321 

12-13 

10 . 8-1 1 . 4 

8 

4 
3 

ascertained.  I  give  here,  therefore,  the  weights  and  lengths  of 
the  spleen,  liver,  and  kidneys  of  five  Coptic  bodies,  and  compare 
them  with  the  average  weight  of  the  same  organs  in  adults  of  the 
present  time. 


PATHOLOGICAL  LESIONS  IN  COPTIC  BODIES  151 

These  Coptic  weights  correspond  closely  with  those  of  the  same 
organs  of  a  dried  body  of  the  Xllth  Dynasty.  Roughly  speaking, 
the  organs  weigh  in  Coptic  bodies  about  one-tenth  to  one-fifteenth 
of  their  original  weight.  The  length  of  the  liver  and  spleen  of 
Coptic  bodies  is  diminished  by  about  one-half,  whereas  the  kidneys 
retain  very  nearly  their  normal  length. 

One  spleen,  however,  instead  of  weighing  12  gm.,  weighed  27  gm., 
that  is,  nearly  double  the  weight  of  the  normal.  It  measured 
20  mm.  in  length  more  than  the  normal  spleen.  The  weight  of 
the  liver  of  the  same  person  was  186  gm. — that  is,  a  little  greater 
than  normal.  In  this  case,  therefore,  we  have  evidence  that  there 
was  during  life  some  hypertrophy  of  the  spleen. 

The  second  case  (XII)  was  still  more  interesting.  The  dimen- 
sions of  the  spleen  (Plate  XLI,  Fig.  6)  were:  Length,  16  cm.; 
weight,  62  gm.;  breadth,  8  cm. — that  is,  the  spleen  was  at  least 
twice  as  long,  twice  as  broad,  and  weighed  five  times  as  much  as 
the  normal  spleen  of  Coptic  bodies.  In  the  photograph  the  breadth 
is  not  seen,  because  the  spleen  was  bent  on  itself;  an  appearance 
which,  owing  to  the  uniform  blackness,  could  not  be  brought  out 
in  the  photograph.  The  liver  also  was  distinctly  larger  than  normal 
as  it  weighed  280  instead  of  180  gm. 

Microscopical  examination  threw  no  light  on  the  causation  of 
the  enlargement  of  the  volume  of  these  organs,  for  an  enormous 
growth  of  moulds  completely  obscured  the  structure  of  the  organ. 

To  speculate  on  the  actual  cause  of  this  hypertrophy  would  be 
useless.  Malaria  was  most  probably  the  cause  of  it,  and  this 
hypothesis  is  supported  by  the  fact  that  up  to  the  present  day  it  is 
not  a  rare  disease  in  Upper  Egypt  where  these  people  lived. 

I  may  mention,  in  this  connection,  that  I  found  a  similarly 
enlarged  spleen  in  a  Fayoum  mummy,  dating  from  the  Roman 
period.     The  Fayoum  Province  is,  even  now,  infested  with  malaria. 

SUMMARY 

Already  in  several  papers  I  have  drawn  attention  to  the  bad 
state  of  the  teeth  of  ancient  Egyptians. 

It  would  be  difficult,  however,  to  find  anywhere  so  many  diseased 
teeth  as  in  these  Coptic  bodies.     Practically  every  skull,  with  the 


152         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

exception  of  two,1  had  some  serious  dental  defects.  This  may 
perhaps  be  accounted  for  by  the  fact  that  very  little  care  of  the 
dentition  appears  to  have  been  taken.  The  thick  incrustations  of 
tartar  are  sufficient  evidence  that  the  Copts  did  not  clean  their 
teeth  at  all.  In  many  peoples  and  animals  the  absence  of  the  tooth- 
brush is  compensated  for  by  the  fact  that  the  food  is  hard,  fibrous, 
and  raw,  requiring  a  good  deal  of  chewing,  which  mechanically 
cleans  the  teeth.  In  ancient  Coptic  times  this  does  not  appear  to 
have  been  the  case,  for,  in  contrast  to  the  predynastic  bodies  in 
which  attrition  is  very  marked,  this  is  slight,  in  fact  being  less 
marked  than  it  is  in  Egyptians  of  the  present  day. 

It  would  appear,  therefore,  that  the  Copts  of  Antinoe  lived 
chiefly  on  cooked,  soft  food,  chewed  without  an  effort.  Caries, 
moreover,  was  extremely  common,  and  was  possibly  due  to  the 
nature  of  the  food  consumed. 

The  fact  that  many  of  these  people  suffered  from  periodontitis 
and  pyorrhoea  alveolaris2  may  perhaps  have  been  due  to  small 
particles  of  food  lodging  between  the  teeth  and  setting  up  putrefac- 
tion, inflammation,  and  suppuration.  In  Alexandria,  at  the  present 
time,  the  poorer  class  of  natives  take  very  little  care  of  the  teeth, 
and  it  is  perhaps  owing  to  this  fact  that  periodontitis  and  pyorrhoea 
alveolaris  are  exceedingly  common  among  them.  My  friend,  Mr. 
Webb  Jones,  surgeon  to  the  Government  Hospital,  tells  me  that  it 
occurs  in  almost  every  patient  frequenting  this  hospital.  Many 
Europeans  suffer  from  it  also. 

Lastly,  I  found  no  certain  evidence  that  these  people  knew 
anything  about  dentistry.  Surely,  had  the  practice  of  even  simple 
tooth-drawing  been  common,  such  lesions  as  I  have  described,  and 
the  accompanying  excruciating  pain,  would  have  been  avoided  by 
this  very  simple  operation. 

The  occurrence  of  spondylitis  deformans  among  ancient  Copts 
is  one  more  proof  that  the  disease  has  existed  throughout  Egypt 

1 1  do  not  give  a  detailed  account  of  five  skulls  which  were  given  to  a  foreign 
museum.  As  the  mouths  were  not  opened  in  order  not  to  spoil  them,  I  cannot  say  for 
certain  how  many  teeth  were  bad,  but  I  ascertained  that  all  of  them  had  diseased  teeth. 

2  The  disease  is  almost  as  old  as  the  human  race.  At  any  rate,  I  have  found 
evidence  of  it  in  prehistoric  skulls  and  in  Greek,  Roman,  Peruvian,  Mexican,  Mero- 
vingian, and  German  skulls. 


PATHOLOGICAL  LESIONS  IN  COPTIC  BODIES  153 

from  the  remotest  times  and  is  independent  of  climate.  It  has 
been  found  by  Dr.  Rietti  and  myself  in  bodies  buried  close  to  the 
Mediterranean  shores,  in  bodies  from  Upper  Egypt  and  in  Nubia. 
Quite  lately  I  have  found  an  example  of  it  in  a  skeleton  from  the 
Meroitic  kingdom  (300  B.C.)  and  buried  in  the  Tropics  at  Merawi, 
one  of  the  hottest  and  dryest  places  in  the  world,  and  others  in 
Christian  skeletons  at  Abou  Menas  and  Abou  Sir  in  the  com- 
paratively damp  region  of  Mariout.  These  skeletons  date  from 
about  500  a.d. 

A  peculiarity  of  the  disease  met  with  in  Coptic  bodies  is  that  it 
was  as  a  rule  localised  to  few  vertebrae,  and  in  one  case  to  two 
vertebrae  and  one  rib. 

The  exostosis  of  the  pelvis  and  the  inflammatory  lesions  described 
in  various  parts  of  the  skeleton  call  for  no  particular  comment. 

The  arthritis  of  the  tempero-maxillary  condition  described  in 
this  paper  was  a  rare  disease  among  Egyptians,  for  I  do  not  possess 
another  specimen. 

Cases  of  hypertrophy  of  the  middle  turbinated  bones  in  ancient 
peoples  have  not  been  described  before,  as  far  as  I  know.  Since 
writing  this  paper,  however,  I  have  seen  another  Egyptian  skull, 
dating  from  about  1000  B.C.,  in  which  the  nasal  passages  on  both 
sides  were  completely  blocked  by  hypertrophy  of  the  turbinated 
bones,  and  I  have  also  found  similar  unilateral  lesions  in  two  Greek 
skulls  dating  from  the  time  of  Alexander  the  Great. 

Pathological  changes  of  the  soft  parts,  recognisable  macroscopi- 
cally,  were  not  common.  Judging  from  the  two  cases  of  hyper- 
trophied  spleen  which  were  found,  it  appears  probable  that  these 
people  suffered  from  malaria,  but  nothing  definite  can  be  said  until 
a  large  number  of  bodies  coming  from  the  same  locality  have  been 
examined. 

DESCRIPTION  OF  PLATES  XXXIX-XLIV1 
(For  particulars  see  text) 

PLATE  XXXIX 

Fig.  1. — Coptic  body  with  prolapse  of  rectum.  The  body,  with  the  excep- 
tion of  the  head  and  feet,  was  dressed  in  a  long  linen  shirt.  Notice  that  the 
parts  not  covered  by  the  sheet  have  remained  white. 

Fig.  2. — Body  with  (a)  deep  abscess  in  back. 

.1 0  1  of  the  photographs  by  Dr.  Rietti. 


154         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

PLATE  XL 

Fig.  3. — Lungs  and  heart  stained  intensely  black. 
Fig.  4. — Distended  rectum  and  sigmoid  flexure. 

PLATE  XLI 

Fig.  5.- — Normal  spleen. 
Fig.  6. — Hypertrophied  spleen. 
Fig.  7. — Kidney. 
Fig.  8. — Liver. 

plate  xm 

Fig.  9. — Skull  with  cap  removed.  D.M.  =  dura  mater.  Part  of  the  brain 
visible  in  situ. 

Fig.  10. — Skull  showing  falx  cerebri  in  situ. 

plate  xllti 

Fig.  11. — Fibula.    Ossification  of  lateral  ligament. 

Fig.  12. — Hypertrophied  middle  turbinated  bone. 

Fig.  13. — Defect  of  ossification  in  sternum. 

Fig.  14. — Fractured  rib. 

Fig.  15. — Edentulous  upper  jaw.  The  loss  of  teeth  was  probably  due  to 
pyorrhoea  alveolaris,  as  the  corresponding  mandible  showed  all  the  lesions  of 
that  disease. 

Fig.  16. — Rib  with  articular  facet  (^4)  greatly  enlarged  and  eburnated. 

Fig.  17. — From  the  same  skull  as  Fig.  25.  The  first  molar  (A)  is  exten- 
sively decayed  and  a  sinus  leads  from  it  into  the  nasal  cavity. 

Fig.  18. — Pyorrhoea  alveolaris.  At  (a)  the  tooth  has  fallen  out,  and  the 
alveolus  has  been  completely  absorbed,  except  for  a  thin  ridge  of  bone  at  the 
superior  border.  At  (c)  the  alveolus  has  been  almost  completely  absorbed. 
The  alveolus  of  the  neighbouring  outer  tooth  has  been  almost  completely 
absorbed,  so  that  the  fang  is  nearly  bare,  and  at  (J)  a  sinus  has  formed.  There 
has  been  absorption  round  the  neck  of  that  tooth  also. 

Fig.  19. — Dorsal  vertebra  with  (a)  an  eburnated,  enlarged  facet  for  articu- 
lation with  rib.  The  lower  anterior  border  of  body  presents  a  marked  exo- 
stosis (/). 

Fig.  20. — Teeth  with  marked  transverse  striation. 

Fig.  21. — Terminal  phalanx.  There  is  considerable  formation  of  new  bone 
round  insertion  of  flexor  digitorum  profundus.  The  ungual  extremity  is  very 
lough. 

Fig.  22. — Hallux  with  exostosis  due  to  chronic  inflammation.  At  A  an 
osseous  ridge  round  insertion  of  long  flexor  (tight  boots?).  The  ungual  end 
is  greatly  roughened  and  has  a  worm-eaten  appearance. 

Fig.  23. — Similar  to  Fig.  22. 


PLATE  XXXIX 


PLATE  XL 


PLATE  XLI 


PLATE  XLII 


PLATE  XLIII 


PLATE  XLIV 


PATHOLOGICAL  LESIONS  IN  COPTIC  BODIES  155 

Fig.  24. — Exostosis  of  pelvis.     A  points  to  groove  in  exostosis. 
Fig.  25. — Pyorrhoea  alveolaris.     The  second  lower  molar  is  extensively 
decayed.     (See  also  Plate  XLIII,  Fig.  17.) 

PLATE  XLIV 

Fig.  26. — Last  lumbar  vertebra.  Thickening  of  anterior  border  of  body 
with  marked  absorption  of  bone  at  A . 

Fig.  27. — Exostosis  of  pelvis.  (See  also  Plate  XLIII,  Fig.  24.)  A,  B, 
and  C  point  to  deep  grooves  in  exostosis. 

Fig.  28. — Exostosis  at  tip  of  acromion. 

Fig.  29. — Pyorrhoea  alveolaris.  The  alveoli  of  the  third  molar  have  been 
completely  absorbed,  the  tooth  being  attached  by  its  centre  only. 

Fig.  30. — Marked  periostitis  over  great  trochanter. 


ON   THE   DISEASES   OF   THE   SUDAN  AND   NUBIA   IN 

ANCIENT  TIMES 

(Mitteilungen  zur  Geschichte  der  Medizin  u.  der  N aturwissenschaften, 
No.  58,  Vol.  XIII  [1914],  No.  4) 

During  the  winter  of  1913,  I  had  an  opportunity  of  witnessing, 
for  a  few  days,  the  excavations  then  in  progress  at  Merawi  (Sudan) . 
Professor  Griffith,1  of  Oxford,  who  was  directing  the  work,  gave  me 
every  facility  for  studying  the  skeletons  still  in  the  graves  and  the 
few  skulls  and  bones  which  he  had  collected.  He  also  allowed  me  to 
examine  the  specimens  which  he  had  dug  up  at  Faras  in  191 2. 

I  am  informed  by  Professor  Griffith  that  the  skeletons  at  Merawi 
dated  roughly  from  the  time  of  the  XXVth-XXVIth  Dynasties 
(i.e.,  about  750-500  B.C.),  and  that  those  from  Faras  were  of  the 
Meroi'tic  age  (i.e.,  about  100  b.c. — 300  a.d.). 

Merawi2  is  situated  on  the  Nile  (18°  N.),  and  Faras  lies  a  few 
miles  north  of  Wady  Haifa,  near  the  second  cataract  of  the  Nile. 

I  made  no  attempt  to  measure  the  skeletons,  as  this  will  be  done 
by  a  competent  anthropologist.  I  ascertained,  however,  that  the 
people  buried  at  Merawi  and  Faras  were  of  two  distinct  races,  the 
first  probably  Egyptian  and  the  other  unmistakably  negroid. 

At  Merawi,  most  of  the  skeletons  which  I  saw  were  still  in  their 
graves,  and  sadly  altered  by  the  action  of  the  sand.  At  Faras,  on 
the  other  hand,  the  bones  had  been  removed  from  the  graves  the 
year  before,  duly  labelled,  and  placed  in  a  closed  room  of  a  mud-hut. 

1  To  Professor  and  Mrs.  Griffith,  I  may  be  allowed  to  express  here  my  warmest 
thanks  for  their  kindness  to  my  wife  and  myself  on  this  and  several  other  occasions. 
To  His  Excellency,  the  Sirdar  and  Governor  General  of  the  Sudan,  General  Sir  Reginald 
Wingate,  and  His  Excellency  Jackson  Pasha,  Governor  of  Merawi  Province,  I  am 
under  great  obligation  for  all  the  facilities  they  gave  me.  Sir  Reginald  Wingate  and 
the  Government  of  the  Sudan  have  lately  issued  an  order  according  to  which  all 
ancient  human  remains  discovered  during  excavations  are  to  be  examined  by  a  com- 
petent anatomist,  either  at  the  time  of  excavation  or  afterwards.  When  will  the 
enlightened  governments  of  Europe  follow  suit  ? 

2  Merawi  (or  Meroe,  or  Merowe)  is  close  to  the  ancient  Napata.  It  must  not  be 
mistaken  for  another  Meroe  or  Merowe  which  is  situated  further  south. 

156 


DISEASES  OF  THE  SUDAN  IN  ANCIENT  TIMES  157 

These  specimens  were  in  better  condition,  as  the  dryness  of  the 
atmosphere  had  rendered  them  resistant.  Fragments  from  about 
seventy  different  bodies  were  left,  and  there  was  hardly  a  single 
perfect  bone;  a  few  debris  of  vertebrae,  a  sacrum,  or  a  piece  of  an 
ulna,  a  radius,  a  femur,  a  mandible  perhaps  represented  all  that  was 
left  of  one  body.  All  the  pathological  specimens  were  set  aside  and 
sent  off  to  Alexandria,  where  they  were  examined  at  leisure. 

The  first  difficulty  was  to  distinguish  between  the  changes  caused 
by  the  method  of  burial  and  true  pathological  alterations.  Had  this 
cause  of  error  been  really  appreciated  in  the  past,  such  a  diagnosis  as 
syphilitic  ulceration  would  not  have  been  made,  only  to  be  contra- 
dicted afterwards. 

At  Merawi,  the  bodies  were  buried  in  brick-lined  graves  filled 
with  sand,  and  the  effects  of  pressure  on  the  long  bones  and  the  skulls 
were  very  marked.  The  former,  for  instance,  were  generally  found 
broken  in  several  places,  and,  through  the  cleanly  cut  fracture,  the 
sand  had  penetrated  into  the  medullary  canals,  which  it  filled  from 
end  to  end,  the  fine,  spongy  tissue  being  completely  destroyed  in 
some  skeletons.  These  fractures  were  very  common,  especially  in 
the  long  bones  of  the  lower  limbs,  the  femurs  suffering  most.  The 
neck  of  the  femurs  and  the  iliac  bones  were  not  infrequently 
smashed  or  completely  destroyed  by  the  same  agency.  The  sand 
also  worked  its  way  into  the  heads  of  the  bones,  especially  into  the 
head  of  the  femur,  and  eroding  the  superficial  bony  layer  exposed 
and  destroyed  the  cancellous  tissue  below. 

The  sand  had  occasionally  shifted  some  of  the  bones  out  of  their 
places,  even  in  intact  burials.  A  sternum,  for  instance,  had  slipped 
into  the  pelvis,  or  a  radius  was  lying  at  right  angles  to  the  ulna. 

The  most  remarkable  changes  due  to  sand  erosion  were  seen  in 
the  skull.  The  sand  penetrating  into  the  sutures,  especially  of 
young  people,  separated  the  bones  of  the  skull  from  one  another 
almost  as  neatly  as  an  anatomist  might  have  done  it.  Through  the 
sutures  the  sand  infiltrated  between  the  inner  and  outer  tables  of  the 
skull,  and  then  the  former  often  gave  way  in  places.  Curious 
erosions  were  thus  formed,  which  were  distinguishable  from  patho- 
logical processes  by  the  absence  of  newly  formed  bone  and  of  other 
signs  of  inflammation  at  the  edge  of  the  eroded  patch.     The  losses 


IS8         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

of  substance  so  produced  exactly  resembled  the  syphilitic  lesions  ( ?) 
described  by  Fouquet  in  old  Egyptian  skulls. 

Similar  losses  of  substance  caused  by  the  action  of  sand  occurred 
on  the  external  table  of  the  skull  also,  and  occasionally  it  was 
extremely  difficult  to  know  whether  such  defects  were  due  to  a  patho- 
logical process  or  not.  In  one  case,  indeed,  even  now,  after  pro- 
longed examination,  I  am  unable  to  decide  to  what  agency  the  loss 
of  substance  was  due.  The  lesion  in  question  consists  of  a  hole  in 
the  lower  third  of  the  frontal  bone  which  measures  o .  7  cm.  in  its 
longest  and  0.3  cm.  in  its  widest  diameter.  Its  walls  are  quite 
smooth,  somewhat  rounded  off  on  the  inner,  but  not  on  the  outer 
side,  and  there  are  no  other  signs  of  inflammation  in  the  neighbour- 
hood. At  the  upper  edge,  a  smooth  groove  implicates  the  upper 
layer  of  the  external  table  only.  There  are  no  signs  of  inflammation 
round  this,  but  the  groove  is  so  smooth  and  even  that  it  is  difficult 
to  believe  that  it  has  been  caused  by  gritty  sand.  On  the  whole,  I 
feel  inclined  to  think  that  we  are  here  in  the  presence  of  an  injury, 
possibly  an  old  and  healed  perforating  wound  of  the  skull. 

No  other  case  of  disease  of  the  roof  of  the  skull  nor  of  the  nose 
was  discovered,  but  as  the  turbinated  bones  were  usually  com- 
pletely smashed  the  detection  of  pathological  changes  in  the  nose 
was  often  impossible. 

Wormian  bones. — These  bones  were  not  very  numerous,  a  few, 
including  a  very  large  one,  occurring  in  the  lambdoid  sutures  and 
some  on  the  coronal  and  sagittal  sutures.  I  did  not  discover  a  single 
one  in  the  face.  Three  typical  specimens  of  os  epactal  and  one 
specimen  of  a  double  os  epactal  were  found. 

Lesions  and  diseases  of  the  teeth. — Malpositions  were  rare,  and  the 
teeth  were  beautifully  and  regularly  planted  as  a  rule.  In  one 
cranium  the  alveoli  were  not  in  their  normal  position,  but  as  the 
teeth  had  fallen  out  it  was  impossible  to  be  certain  as  to  the  exact 
malposition;  in  another  skull,  the  second  right  upper  molar  was  dis- 
placed to  the  inner  side.  There  were  also  several  good  examples  of 
impacted  teeth. 

Two  malformations  were  observed  in  the  fangs  of  the  grinding 
teeth.  In  the  first,  two  fangs  were  so  bent  that  their  tips  met,  and 
in  the  other  the  three  fangs  were  joined  together  into  one  mass. 


DISEASES  OF  THE  SUDAN  IN  ANCIENT  TIMES  159 

When  the  sand  had  been  removed  the  teeth  nearly  always  looked 
very  clean  and  white;  a  few  were  stained  yellow,  and  deposits  of 
tartar  were  occasionally  present.  As  a  rule,  however,  the  enamel, 
except  on  the  grinding  surface  or  cutting  edge,  was  in  very  good 
condition,  and  at  first  I  had  the  impression  that  the  teeth  of  these 
people  were  very  fine.  This  impression  was  dissipated  on  more  care- 
ful examination. 

Almost  all  the  teeth  showed  signs  of  considerable  attrition. 
This  phenomenon  has  been  observed  already  in  predynastic  bodies, 
in  old  Egyptian  mummies,  and  in  Greek  and  Coptic  bodies,  by 
Flinders  Petrie,  Fouquet,  De  Morgan,  Elliot  Smith,  Wood  Jones, 
Derry,  and  also  Rietti  and  myself. 

Nevertheless,  it  is  worthy  of  being  carefully  studied,  as  from  this 
and  other  conditions  of  the  teeth  one  may  form  an  opinion  as  to  the 
food  of  these  people.  At  Merawi  and  Faras  this  alteration  began 
quite  early  in  life,  as  in  some  young  skulls  the  deciduous,  grinding 
teeth  showed  marked  attrition.  The  molars  were  worn  down  irregu- 
larly, the  often  crescented  and  sharply  cut  cavity  being  generally 
more  marked  on  the  lingual  side  of  the  upper  and  on  the  labial  side 
of  the  lower  teeth.  This,  indeed,  appears  to  be  the  rule  in  deciduous 
and  in  permanent  teeth  also. 

The  rapidity  with  which  this  wearing  down  of  the  crown  pro- 
gresses was  estimated  by  the  amount  of  attrition  in  the  teeth,  the 
age  of  which  could  be  known  with  some  accuracy.  The  first 
mandibular  permanent  molar,  for  instance,  erupts  at  the  age  of 
seven  years  and  three  months  (according  to  others,  at  six  years  and 
nine  months),  and  the  canine  at  ten  years  and  seven  months,  i.e., 
about  three  years  afterwards.  Now  in  several  mandibles,  in  which 
the  canines  were  just  pushing  through  the  bone,  the  first  molars 
showed  very  considerable  attrition  already.  In  three  years,  there- 
fore, most  of  the  mischief  had  been  done. 

Similarly,  during  the  interval  between  the  eruption  of  the  second 
and  third  molars,  the  crown  of  the  former  had  sometimes  become 
much  worn;  though,  perhaps,  the  degree  of  attrition  was  generally 
less  marked  than  in  the  first  case. 

Attrition  affected  all  the  teeth,  though  to  a  different  degree. 
The  first  molars  were  most  worn,  then  the  second  premolars,  the 


160         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

second  molars,  and  to  a  less  extent  the  first  premolars,  the  canines, 
the  incisors,  and  lastly  the  third  molars. 

The  cavities  formed  by  long  attrition  differed  exceedingly  accord- 
ing to  the  position  of  the  teeth.  In  the  incisors,  canines,  and  often 
the  first  premolars,  a  bow-like  cavity  was  formed.  In  the  molars 
and  second  premolars,  the  grinding  generally  gave  rise  at  first  to 
smooth,  more  or  less  crescented  cavities,  and  these,  as  has  been 
explained  before,  were  usually  deeper  on  the  lingual  side  of  the  upper 
and  on  the  labial  side  of  the  lower  teeth.  Later  on,  the  teeth  were 
ground  down  evenly;  the  smooth  surface  so  produced  being  inclined 
to  the  labial  side  in  the  upper  jaw,  and  to  the  lingual  side  in  the 
mandible. 

Although  most  teeth  were  ground  down,  and  although  the 
change  evidently  progressed  rapidly  in  early  youth,  yet  it  was  never 
as  marked  as  in  predynastic  skulls  or  modern  Egyptians.  It  pro- 
gressed in  old  people  at  a  much  slower  rate  than  in  young,  sometimes 
stopping  altogether  in  the  old. 

In  many  cases  the  pulp  cavity  was  opened  by  the  attrition,  yet 
this  lesion  was  not  frequently  followed  either  by  caries  or  abscesses. 
The  latter  were  often  connected  with  carious  teeth,  or  with  perial- 
veolar disease. 

A  cursory  examination  of  the  skulls  made  on  the  spot  showed 
that  about  12  per  cent  of  the  skulls  had  carious  teeth.  This,  how- 
ever, gives  a  very  erroneous  idea  of  the  real  state  of  things,  for  being 
pressed  for  time,  my  examination  was  somewhat  superficial.  More- 
over, the  crowns  of  a  large  number  of  teeth  had  been  broken  off; 
many  teeth  had  dropped  out  and  could  not  be  found,  some  of  which 
may  have  been  carious. 

Of  the  thirty-six  skulls  and  fragments  of  mandibles  from  Faras 
and  Merawi  which  I  took  home  to  examine,  all  but  two  showed 
carious  teeth.  As  a  rule,  the  crown  of  the  tooth  was  not  affected, 
and  the  carious  hole  was  situated  on  the  proximal  or  the  distal 
surfaces,  or  on  the  labial  or  lingual  sides. 

Occasionally  the  results  following  on  caries  were  exceedingly 
severe  and  must  have  caused  agony  during  life.  Let  us  examine 
some  of  them  more  carefully. 

The  first  case  was  the  left  maxilla  of  a  very  young  person,  which 
had  also  an  impacted  tooth,  just  behind  the  first  and  second  upper 


DISEASES  OF  THE  SUDAN  IN  ANCIENT  TIMES  161 

incisors.  The  two  incisors,  canines,  and  first  premolars  had  either 
fallen  out  or  their  crowns  had  been  broken  off,  after  death. 

The  second  premolar  was  carious  on  its  inner,  proximal  side, 
and  had  evidently  been  infected  by  the  first  molar,  which,  together 
with  the  second  molar,  was  extensively  carious.  In  connection  with 
the  first  molar  there  was  an  abscess  as  large  as  a  pea,  opening  into 
the  mouth. 

In  another  mandible  there  was  extensive  caries  on  the  lingual  side 
of  the  second  premolar.  The  first  molar  had  probably  been  carious 
also,  and,  at  any  rate,  there  had  been  considerable  inflammation 
round  it,  which  was  shown  by  the  rough  state  of  the  alveolus.  An 
abscess  had  formed  round  one  of  these  teeth,  probably  of  the  first 
molar,  and  the  pus  had  found  its  way  from  one  alveolus  to  the  other, 
through  a  sinus  which  admitted  a  large  probe.  It  had  then  worked 
through  the  bone  on  the  labial  side  of  the  second  premolar,  and 
lastly  into  the  mouth. 

In  another  case  an  abscess  as  large  as  a  pea  existed  at  the  root 
of  the  left  mandibular  canine.  All  the  teeth  showed  great  attrition, 
and  the  pulp  canal  of  the  canine  had  thus  been  opened.  The  pus 
in  this  case  had  welled  up  on  the  inner  side  of  the  canine,  where  its 
track  was  easily  followed. 

An  abscess  similar  to  the  last  was  found  in  another  mandible, 
in  which  the  track  of  the  pus  at  the  base  of  one  incisor  opened  into 
the  alveoli  of  both  neighbouring  incisors. 

Among  the  most  important  and  frequent  lesions  were  those 
secondary  to  periodontal  disease.  Many  teeth  were  not  in  position 
and  looked  as  if  pushed  forward ;  the  whole  or  part  of  the  fangs  were 
exposed,  owing  to  the  absorption  of  the  alveoli  by  a  chronic  inflam- 
matory process  or  periodontitis. 

In  early  cases  the  alveoli  were  partly  absorbed,  so  that  in  each 
tooth  part  of  the  fang  was  exposed.  Later  on,  the  alveoli  dis- 
appeared on  one  side,  and,  in  consequence,  the  fangs  were  bare  along 
their  whole  length.  In  some  skulls  the  alveoli  had  gone  almost 
completely,  most  of  the  teeth  had  dropped  out,  and  the  few  remain- 
ing were  attached  to  the  skull  only  by  the  tip  of  the  fangs. 

We  are  here,  I  think,  in  the  presence  of  cases  of  rarefying 
periodontitis,  and  pyorrhoea  alveolaris,  with  consequent  loosening 
and  final  shedding  of  the  teeth.     It  is  most  probably  due  to  this 


162         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

cause  that  some  of  the  skulls  were  absolutely  toothless,  the  alveolar 
borders  having  been  completely  absorbed. 

This  disease  rages  now  at  Faras  as  it  did  two  thousand  years 
ago,  for  during  my  short  stay  there  I  was  consulted  by  several  men, 
who  in  consequence  of  pyorrhoea  had  lost  nearly  all  their  teeth  and 
were  in  a  fair  way  of  shedding  the  remaining  few.  It  is  spread  all 
over  Egypt,  and  when  in  the  desert  of  Sinai  near  Akaba,  I  was 
visited  by  the  garrison  of  seven  men  who  held  a  small  fort  there. 
All  seven  showed  the  typical  symptoms  of  this  disease  and  were  in  a 
wretched  state  of  health  in  consequence. 

Two  perfectly  toothless  mandibles  and  maxillae  are  worthy  of 
notice,  for  judging  from  the  state  of  the  cranial  sutures,  it  is  ex- 
tremely probable  that  their  owners  were  still  middle-aged  at  the 
time  of  death.  Yet,  they  had  lost  their  teeth  some  considerable 
time  before  death. 

To  resume:  The  lesions  of  the  teeth  found  at  Marawi  and  Faras 
may  be  tabulated  as  follows:  (i)  impaction;  (2)  attrition;  (3) 
caries;  (4)  abscesses  and  fistulae;  (5)  periodontitis  and  pyorrhoea 
alveolaris.  On  the  whole,  therefore,  the  state  of  the  dentition  in 
those  times  was  remarkably  bad. 

Injuries  of  bones. — Injuries  of  bones  in  the  shape  of  fractures 
appear  to  have  been  fairly  common,  as  I  came  across  four  of  them 
in  a  very  short  time. 

The  first,  discovered  at  Merawi,  was  an  oblique,  simple  fracture 
at  the  junction  of  the  lower  and  middle  thirds  of  the  humerus. 
There  was  a  good  deal  of  callus,  and  the  fracture  had  been  very  badly 
set,  so  that  a  marked  deformity  existed. 

In  the  case  of  a  fractured  ulna,  it  is  doubtful  whether  the  lesion 
was  due  to  disease  or  to  injury.  At  the  junction  of  the  lower  and 
middle  thirds  of  the  bone,  there  was  an  oblong,  osseous  swelling 
which  entirely  surrounded  the  bone.  The  specimen  had  been 
waxed  before  I  saw  it,  and  its  condition  could  not  be  satisfactorily 
ascertained.  I  believe,  however,  that  the  lesion  was  due  to  disease 
and  not  to  injury,  for  there  were  two  holes  with  smooth,  rounded 
walls,  evidently  two  sinuses,  opening  over  the  swelling  and  probably 
caused  by  some  disease  of  the  shaft  of  the  ulna,  e.g.,  osteomyelitis, 
which  led  to  formation  of  a  sinus,  fracture  of  the  bone,  and  incom- 


DISEASES  OF  THE  SUDAN  IN  ANCIENT  TIMES  163 

plete  formation  of  callus  round  the  fracture.  That  osteomyelitis 
existed  in  Old  Egypt  is  shown  by  a  typical  ancient  specimen  of  this 
disease,  now  in  the  Cairo  Pathological  Museum. 

A  third  specimen  is  a  fracture  of  the  lower  end  of  the  fibula. 
The  fracture  had  not  been  well  set,  and  there  was  considerable 
twisting  of  the  bone.  It  did  not  extend  into  the  joint,  the  lower  end 
of  the  bone  being  normal. 

At  Faras,  I  found  a  healed,  impacted  fracture  of  the  upper  part 
of  the  femur.  Only  part  of  the  bone  was  present,  but  although 
the  fracture  was  completely  healed,  there  had  been  considerable 
shortening.  Further,  the  numerous  osteophytes  round  the  fracture 
showed  that  the  healing  process  had  taken  a  very  long  time,  and 
that,  probably,  there  had  been  some  suppuration  also. 

Such  a  fracture  is  very  difficult  to  treat,  and  even  now  the  results 
obtained  are  often  very  unsatisfactory.  We  cannot  wonder,  there- 
fore, that  the  old  Meroites  were  not  more  successful. 

The  two  specimens  of  uncomplicated  fractures,  however,  namely 
of  the  humerus  and  fibula,  do  not  give  one  a  very  high  opinion  of 
the  surgery  of  those  days,  as  the  final  results  of  the  treatment  can 
only  be  considered  as  bad.  This  observation  agrees  very  well  with 
what  I  have  seen  in  Egypt  of  other  fractures  dating  from  a  similar 
period. 

Arthritic  lesions.  Spondylitis  deformans. — The  investigations  of 
Elliot  Smith,  Wood  Jones  and  Derry  in  Nubia,  and  of  Armand 
Ruffer  and  Rietti  in  Egypt  have  shown  that  this  disease  was  com- 
mon in  predynastic,  dynastic,  Greek,  Roman,  and  Coptic  times. 
At  the  Pathological  Museum  of  the  Medical  School  in  Cario,  I 
have  arranged  specimens  of  Egyptian  vertebrae  exhibiting  the 
characteristic    signs  of   this   disease,    dating   from    4000   B.C.    to 

3OO  A.D. 

I  was  naturally  anxious,  therefore,  to  see  whether  this  disease 
existed  at  Merawi  and  Faras.  At  the  first  site,  owing  to  the  very 
bad  state  of  the  bones,  I  was  for  a  long  time  unsuccessful.  Finally 
I  discovered  in  one  grave  three  lumbar  vertebrae  with  marked  over- 
lipping  of  the  anterior  borders  of  the  bodies.  In  another  grave  were 
two  lumbar  vertebrae,  which  showed  some  overlipping  of  their 
borders  and  were  joined  together  on  one  side  by  a  strong  bridge  of 


1 64         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

new  bone  measuring  about  i .  5  cm.  in  width  and  about  0.5  cm.  in 
thickness. 

At  Faras,  the  vertebrae  which  had  been  saved  were  very  few 
and  badly  preserved.  Three  sacra,  however,  showed  marked  signs 
of  spondylitis  deformans.  This  disease,  therefore,  existed  at  Merawi 
as  well  as  at  Faras;  that  is,  in  two  of  the  dryest  and  hottest  places 
of  the  world,  so  that  it  is  difficult  to  believe  that  it  is  due  to  cold 
and  damp. 

Other  cases  of  arthritis. — The  only  two  other  cases  of  arthritis 
were  found  at  Faras.  The  first  was  a  humerus  in  which  there  was 
a  border  of  new  bone,  more  marked  on  the  anterior  side,  round  the 
anatomical  neck.  The  bone  was  smooth,  white,  and  had  evidently 
been  formed  some  time  before  death. 

The  other  was  the  lower  end  of  a  femur  which  showed  two 
remarkable  osteophytes ;  the  largest  measuring  about  2 . 5  by  2  cm. 
and  more  than  o .  5  cm.  in  its  thickest  part.  This  must  have  caused 
considerable  limitation  of  movement  during  life. 

Considering  the  few  bones  I  had  occasion  to  examine,  it  is  not 
a  little  remarkable  that  not  less  than  six  fragments,  belonging  to 
different  bodies,  should  have  exhibited  signs  of  chronic  arthritis.  It 
'  is  very  probable,  therefore,  that  this  disease  was  very  common. 

Other  lesions  of  bones. — Neither  tubercular  nor  syphilitic  lesions 
were  discovered. 

Two  bones  showed  deformities  which  may  possibly  have  been 
caused  by  rickets.  The  first  was  a  femur  in  which  the  antero- 
posterior curve  was  greatly  exaggerated.  Unfortunately  the  lower 
end  was  missing. 

The  other  case  was  more  instructive.  It  was  a  sacrum  in  which 
the  last  two  vertebrae  were  bent  forward  sharply,  almost  at  right 
angles  to  the  others.  The  whole  sacrum  was  remarkably  light  and 
brittle,  and,  except  for  the  deformation  just  described,  exhibited  no 
other  pathological  changes.  It  appeared  to  me  most  probable  that 
this  deformity  was  due  to  rickets. 

A  word  remains  to  be  said  about  the  age  of  these  people  at  the 
time  of  death.  Were  they  in  fact  a  short-lived  or  a  long-lived  race  ? 
As  we  have  seen,  the  skeletons  were  generally  those  of  adults,  and 
it  is  often  extremely  difficult  to  determine  accurately  the  age  of  an 


DISEASES  OF  THE  SUDAN  IN  ANCIENT  TIMES  165 

adult  person  from  the  state  of  the  skull,  and  the  other  parts  of  the 
skeletons  were  of  no  use  for  that  purpose.  In  both  places  the  state 
of  the  teeth  was  of  little  assistance  in  estimating  the  age  of  these 
people,  as  attrition  was  present  even  in  the  young,  and  the  thickness 
of  the  parietal  bones  and  the  weight  of  the  skull  were  no  guides, 
owing  to  the  bad  state  of  preservation  of  the  specimens. 

In  most  skeletons  the  sutures  with  the  exception  of  the  basilar 
were  still  wide  open  and  there  was  no  sign  of  obliteration,  nor  did 
I  find  a  single  case  of  complete  synostosis  of  the  cranium. 

My  impression,  therefore  was  that  the  majority  of  these  people 
died  before  they  were  fifty  years  old. 


PATHOLOGICAL  NOTES  ON  THE  ROYAL  MUMMIES  OF 
THE  CAIRO  MUSEUM1 

{Mitteilimgen  zur  Geschichte  der  Medizin  u.  der  N aturwissenschaften, 
No.  56,  Vol.  XIII  [1914],  No.  2) 

In  1889,  Sir  Gaston  Maspero,  the  eminent  Director  General  of 
the  Antiquities'  Department  of  Egypt,  published  his  great  mono- 
graph, Les  Momies  royales  de  Deir  el  Bahri,  in  which  he  gave  a 
full  account  of  the  appearances  presented  by  these  mummies  at  the 
time  they  were  unrolled.  Since  that  time  the  royal  mummies  have 
rested  in  the  Cairo  Museum. 

Maspero's  account,  although  supplemented  by  the  notes  of 
Fouquet,  was  that  of  the  pure  Egyptologist,  and  gave  little  consid- 
eration to  anatomy  and  pathology.  Nearly  twenty  years  afterwards, 
Maspero  requested  Elliot  Smith  to  re-examine  the  mummies  and  to 
report  on  their  anatomical  and  pathological  characteristics,  and  I 
feel  sure  everyone  will  agree  that  no  one  could  have  done  the  work 
better.  In  the  course  of  this  enquiry,  however,  it  soon  became 
obvious  that  little  could  be  done  from  an  anatomical  or  pathological 
point  of  view  without  dissection.  This,  of  course,  was  out  of  the 
question,  as  these  mummies  rank  as  archaeological  documents  of  the 
first  importance  and  must  remain  intact.  Fortunately,  however, 
Elliot  Smith  examined  a  large  number  of  mummies  less  exalted  in 
rank  than  the  royal  mummies,  and  on  these  he  based  his  researches 
published  some  years  ago.1  W.  A.  Schmidt,  A.  Lucas,  W.  M.  Codes 
discussed  the  subject  from  the  chemical  point  of  view.  Marc 
Armand  Ruffer  gave  a  full  account  of  the  histology  of  mummies,  or 
in  collaboration  with  W.  R.  Ferguson  also  described  some  of  the 
pathological  lesions  which  can  be  detected  with  the  microscope. 

The  paper  contains  a  full  account  of  the  process  of  embalming, 
but,  considering  that  this  has  been  fully  discussed  elsewhere  and 
reported  at  its  proper  time,  I  may  pass  it  over  to-day.     Many  valu- 

1  Service  des  Antiquites  de  l'figypte,  Catalogue  general  des  Antiquites  egyptiennes 
du  Mitsee  du  Caire,  Nos.  61051-100.  G.  Elliot  Smith,  F.R.S.,  The  Royal  Mummies, 
Le  Caire,  191 2. 

166 


PATHOLOGICAL  NOTES  ON  ROYAL  MUMMIES  167 

able  pathological  observations,  however,  are  scattered  in  this 
memoir,  and  it  is  of  these  only  that  I  wish  to  speak  in  this 
review. 

The  appearance  of  mummies  is  very  deceptive.  At  first  sight,  a 
casual  observer  might  conclude  that  ancient  Egyptians  were  a 
singularly  thin  people,  and  a  glance  at  the  photographs  reproduced 
in  this  volume  would  confirm  him  in  this  manner  of  thinking.  More 
careful  examination  shows  that  this  conclusion  would  be  entirely 
wrong,  and  that  not  only  were  most  of  these  people  well  nourished, 
but  some  suffered  from  marked  obesity. 

The  mummy  of  Ramses  III  (1198-1167  B.C.),1  forinstance,  looks 
like  the  body  of  a  very  thin  man.  Examination  shows  that  the 
wrinkled  skin  forms  behind  the  neck  under  the  chin,  round  the 
thighs  and  joints,  enormous  folds  imbricated  one  over  the  other. 
The  king,  therefore,  was  very  corpulent  at  the  time  of  his  death. 
King  Merneptah  (1225-1215  B.C.)  also  was  a  singularly  fat  man,  for, 
although  the  body  is  now  reduced  to  little  more  than  skin  and  bone, 
the  redundancy  of  the  skin  of  the  abdomen,  thighs,  and  cheeks 
leaves  no  doubt  on  that  point.  The  same  remark  applies  to  King 
Thutmose  II  (about  1501  B.C.),  to  Zabdptahefonkhou,  a  priest 
of  Amon,  and  to  others.  The  skin  of  the  priest  of  Amon,  for 
instance,  is  thrown  into  the  most  curious  folds  owing  to  the  drying 
and  shrinking  of  the  subcutaneous  tissues. 

These  observations  on  the  obesity  of  ancient  Egyptians  I  have 
been  often  able  to  confirm  by  the  examination  of  mummies  and 
dried  bodies  of  all  times.  I  have  in  my  possession,  for  instance,  the 
arm  of  a  mummy  of  the  XXIst  Dynasty,  which  had  been  carefully 
packed  with  earth.  It  is  a  stout  arm  even  now,  though  it  is  evident 
that  the  embalmer  had  not  really  restored  the  limb  to  its  original 
shape,  as  deep  folds  of  the  skin,  some  more  than  one  inch  in  depth, 
show  that  the  arm  was  not  fully  distended  by  the  embalmer's  pack- 
ing, and  that  it  was  much  fatter  than  it  looks  now.  The  skin  of  the 
abdomen  of  a  mummy  of  Persian  times  (500  B.C.),  which  looked 
terribly  emaciated,  was  thrown  into  deep  folds;  the  skin  had  evi- 
dently shrunk  considerably  during  the  mummifying  process,  and 
during  life  that  person  must  have  had  an  imposing  abdomen. 

'  For  the  dates,  T  follow  Urcasted  (A  History  of  Egypt)  whenever  possible. 


1 68         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Similarly,  in  a  Coptic  body  from  Akhmin  (400  a.d.)  which  looked 
like  a  skeleton,  in  spite  of  its  sixteen  hundred  years'  desiccation  in 
hot  sand,  the  skin  of  the  buttocks  showed  the  redundant  folds  of  a 
stout  person.  Pieces  of  skin,  soaked  in  proper  softening  fluid, 
swelled  up  to  their  original  size  and  a  large  amount  of  subcutaneous 
fat  was  demonstrated. 

The  abdominal  wall  of  another  Coptic  mummy,  which  had  been 
simply  dried,  was  more  than  two  inches  thick.  Considering  that 
the  abdominal  wall  of  dried  bodies  is  not  more  than  half  an  inch  in 
thickness  as  a  rule,  the  subcutaneous  tissue  of  this  man  must  have 
been  very  abundant.  In  some  mummies  of  the  XXIst  Dynasty 
(about  900  B.C.),  the  embalmer  filled  out  the  cheeks  of  the  person 
with  a  paste  consisting  of  some  fatty  material  and  sawdust,  or  of 
sand,  evidently  with  the  idea  of  preparing  a  mummy  bearing  some 
likeness  to  the  deceased.  Some  of  these  heads  show  greatly  dis- 
tended cheeks  and  a  good  deal  of  obesity. 

The  point  is  interesting  as  showing  that  many  of  these  people  did 
not  die  of  wasting  diseases  such  as  phthisis,  but  of  some  acute 
disease.  I  have  heard  it  stated  that  many  of  the  statues  now  in  the 
Cairo  Museum  have  the  typical  phthisical  look,  and  in  a  discussion 
which  took  place  some  years  ago  at  the  Institut  Egyptien  it  was 
said  that  their  appearance  showed  that  the  originals  died  of  phthisis. 
The  examination  of  mummies,  however,  points  exactly  to  the  con- 
trary, as  the  majority  were  well-nourished  persons. 

In  this  connection  I  must  allude  to  the  mummy  of  Amenhotep 
III  and  to  the  bones  of  his  son  Ikhnaton,  which  are  described  in  this 
memoir,  as  perhaps  the  most  typical  instance  of  pathological  obesity 
is  shown  in  the  portraits  of  the  heretic,  King  Ikhnaton  (1375-1358 
B.C.).  According  to  Weigall,  one  reason  why  this  monarch's  almost 
ridiculous  appearance  is  faithfully  represented  is  that  he  introduced 
a  very  realistic  form  of  art,  destined,  alas,  to  have  but  too  short  a 
life.     Weigall  says: 

In  the  drawing  of  the  human  figure,  and  especially  that  of  the  Pharaoh, 
there  are  three  very  distinct  characteristics  in  this  new  form  of  art.  Firstly, 
as  to  the  head:  the  skull  is  elongated;  the  chin,  as  seen  in  profile,  is  drawn  as 
if  it  were  sharply  pointed;  the  flesh  under  the  jaw  is  skimped,  thus  giving  an 
upward  turn  to  the  line;  and  the  neck  is  represented  as  being  long  and  thin. 


PATHOLOGICAL  NOTES  ON  ROYAL  MUMMIES  169 

Secondly,  the  stomach  is  made  to  obtrude  itself  upon  the  attention  by  being 
drawn  as  though  from  a  fat  and  ungainly  model.  And  thirdly,  the  hips  and 
thighs  are  abnormally  large,  though  from  the  knees  downwards  the  legs  are  of 
more  natural  size.  This  distortion  of  human  anatomy  is  marked  in  a  lesser 
degree  in  all  the  lines  of  the  body;  and  the  whole  figure  becomes  a  startling 
type  of  an  art  which  seems  at  first  to  have  sprung  fully  developed  from  the 
brain  of  the  boy-Pharaoh  or  from  one  of  the  eccentrics  of  the  Court. 

It  may  be  that  he  had  objected  to  be  represented  in  the  conventional 
manner  and  had  told  his  artists  to  draw  him  as  he  was.  The  elongated  skull, 
the  pointed  chin,  and,  even,  perhaps,  the  ungainly  thighs  could  only  be 
accounted  for  by  some  radical  deformity  on  the  royal  model,  and  that  he  was 
a  well-made  man  in  this  respect  the  recently  discovered  bones  most  clearly 
show.1 

Weigall  also  suggests  that  this  way  of  depicting  the  king  was  due 
to  a  kind  of  renaissance,  and  to  a  return  to  the  archaic  form  of  art,  in 
which  many  of  the  characteristics  just  described  were  prominent. 

This  last  hypothesis  appears  to  me  unnecessary,  and  I  am  con- 
vinced that  we  are  in  presence  of  real  portraits  of  the  monarch. 
True,  the  abdomen  is  rather  prominent  in  other  people  represented 
at  Tell  el  Amarna,  but  this  is  due  chiefly  to  the  peculiar  type  of 
dress  which,  apparently  consisting  of  a  mantle  firmly  tied  below  the 
umbilicus,  emphasised  the  lower  part  of  the  abdomen.  In  persons 
not  wearing  this  dress  the  abdomen  is  flat,  and  even  in  men  attired 
in  the  garment  just  described  it  is  never  as  protuberant  as  in  King 
Ikhnaton. 

In  one  picture,  the  king  is  represented  distributing  collars  of  gold 
from  a  balcony,  and  his  abdomen  actually  hangs  over  the  edge  of  the 
balcony:  a  most  realistic  piece  of  portraiture. 

The  thighs  of  the  queen  and  daughters  are  perhaps  accentuated, 
but  the  abdomen  is  flat.  One  of  the  princesses,  however,  appears  to 
have  inherited  some  of  her  father's  characteristics,  as  she  is  occa- 
sionally represented  with  very  full,  round  thighs,  contrasting  with 
those  of  the  sisters  standing  in  front  and  behind  her. 

The  very  thin  calves  of  Ikhnaton  show  that  the  artist  faithfully 
copied  nature,  for  great  corpulency  accompanied  by  very  thin  calves 
is  not  infrequent  in  the  East  nor  even  rare  in  Europe.  Witness,  for 
instance,  the  famous  portrait  by  Valesquez  in  the  Munich  Gallery, 

1  Weigall,  Ikhnaton,  Pharaoh  0}  Egypt,  1910. 


170         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

in  which  the  contrast  between  the  truly  enormous  abdomen  and  the 
thinner  lower  extremities  is  striking. 

The  extreme  corpulency  of  the  king  may  have  been  responsible 
for  his  politics.  On  account  of  his  obesity  he  probably  disliked 
physical  exertion,  and  this  may  have  been  the  reason  why  he  per- 
sistently refused  to  lead  his  army  to  war  when  the  outlying  provinces 
of  his  kingdom  were  threatened.  Time  after  time  he  was  appealed 
to  for  help,  but  he  remained  at  home  and  thus  became  responsible  for 
the  loss  of  some  of  the  foreign  possessions  of  Egypt. 

Another  picture  from  Tell  el  Amarna  may  be  referred  to  here  {El 
Amarna,  I,  II,  XVIII).  It  is  divided  into  two  halves,  that  on  the 
left  showing  the  household  of  Ikhnaton,  that  on  the  right  the  house- 
hold of  his  predecessor  Amenhotep  III.  It  shows  that  Ikhnaton's 
obesity  was  inherited,  for  father  and  son  show  the  same  abdominal 
deformity.  Indeed,  the  whole  royal  family  is  distinctly  stout,  in 
contrast  with  the  three  lean  female  servants  on  the  extreme  right. 
The  mummy  of  Amenhotep  III  (1411-1375  B.C.)  is  among  those 
examined  by  Elliot  Smith,  and,  naturally,  I  looked  with  great 
interest  to  see  whether  the  mummy  would  confirm  the  diagnosis 
made  from  the  pictures.  Unfortunately,  the  body  was  in  such  a 
wretched  state  that  nothing  could  be  deduced  with  certainty  from 
its  examination. 

It  may  be  noted  that,  according  to  Elliot  Smith,  the  skull  of 
Ikhnaton  presents  a  number  of  interesting  and  significant  features. 
The  cranium  is  broad  and  relatively  flattened,  its  measurements 
being  18.9  cm.  in  length;  and  15.4  cm.  in  breadth;  13.6  cm.  in 
height;  9.9  cm.  minimal  frontal  breadth,  with  a  circumference  of 

54-5  cm. 

Elliot  Smith  adds : 

Although  15.4  cm.  is  quite  an  exceptional  breadth  for  an  Egyptian  skull, 
all  the  other  numbers  are  smaller  than  those  obtained  in  the  case  of  Amenhotep 
III.  Nevertheless,  the  form  of  the  cranium  and  the  fact  that  it  is  exceptionally 
thin  in  some  places,  and  relatively  thick  in  others,  indicate  that  a  condition  of 
hydrocephalus  was  present  during  life. 

Professor  A.  R.  Ferguson,  professor  of  pathology  in  the  Cairo  School 
of  Medicine,  is  of  opinion  that  the  signs  of  this  disease  are  unques- 
tionable. Whether  the  skull  is  Ikhnaton's  or  not,  it  is  interesting  to 
find  that  hydrocephalus  existed  about  thirty-five  hundred  years  ago. 


PATHOLOGICAL  NOTES  ON  ROYAL  MUMMIES  171 

The  bones  supposed  to  be  Ikhnaton's  are  also  in  the  Museum, 
and  Elliot  Smith  fully  discusses  their  authenticity.  In  my  opinion, 
however,  the  evidence  that  they  are  Ikhnaton's  is  by  no  means 
conclusive,  but  not  having  had  an  opportunity  of  examining  them, 
I  leave  this  question  for  another  occasion. 

Death  from  violence. — The  king  Saknounra  Tionaken  (about  1870 
B.C.),  of  the  XVIIth  Dynasty,  died  from  injuries,  and  it  is  clear  from 
the  examination  of  his  mummy  that  he  met  his  death  in  an  attack 
by  at  least  two,  and  possibly  more,  persons  armed  with  at  least  two 
(perhaps  three  or  more)  implements,  one  of  which  was  probably  an 
axe  and  another  a  spear.  The  absence  of  any  injury  to  the  arms, 
or  to  any  other  part  of  the  body,  shows  that  no  resistance  could  have 
been  offered  to  the  attack.  It  is  quite  possible  that  the  wounds 
may  have  been  inflicted  while  Saknounra  was  lying  down  on  the 
right  side. 

The  mode  of  death  of  this  king  had  been  unknown  before  his 
mummy  was  examined.  His  wars  against  the  Hyksos  had  not  been 
forgotten,  but  it  had  never  been  ascertained  that  he  had  died  in 
battle. 

A  wound  probably  caused  by  a  fall  backwards  was  found  in  the 
occipital  scalp  of  Princess  Meritamon.  This  had  apparently  been 
produced  ante-mortem. 

Mutilations. — Mutilations  are  rare.  We  note  that  there  is 
no  evidence  that  women  were  circumcised,  but  the  bodies  are  in 
such  a  state  that  it  would  often  be  difficult  to  state  with  certainty 
whether  such  an  operation  had  been  done.  The  men,  on  the 
other  hand,  always  appear  to  have  been  circumcised,  and  from 
the  fact  that  a  boy  eleven  years  old,  found  in  the  tomb  of  Amen- 
hotep  II  (1420  B.C.),  was  still  uncircumcised,  it  may  be  argued 
that  this  operation  was  performed  at  a  later  age,  as  in  present 
times. 

The  question  of  the  treatment  of  the  genital  organs  after  death, 
whether,  for  instance,  they  were  buried  separately  or  not,  is  a  diffi- 
cult one.  It  is  not  always  very  easy  to  say  whether  the  genital 
organs  are  present  or  not  in  mummies,  and  it  has  happened  that  two 
observers  have  come  to  different  conclusions  with  regard  to  this 
apparently  easily  ascertainable  fact. 


172        STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  pudenda  were  present  in  Ahmose  I  (1557  B.C.),  Thutmose 
IV  (1411  B.C.),  Amenhotep  II  (1420  B.C.),  and  Yuaa,  and  the  state 
of  affairs  in  Thutmose  II,  Thutmose  III  (1447  B.C.),  and  an  unknown 
man  in  Nibsoni's  coffin  was  uncertain.  In  the  case  of  Seti  I  (1292 
B.C.)  the  wrappings  were  not  removed,  and  therefore  no  definite 
statement  of  the  mode  of  treatment  of  the  pudenda  can  be  made. 

A  very  curious  feature  of  Merneptah's  (1215  B.C.)  mummy  is  the 
complete  absence  of  the  scrotum,  but  not  of  the  penis.  Midway 
between  the  root  of  the  penis  and  the  anus  a  transverse  scar  is 
visible.  It  represents  the  place  from  which  the  scrotal  sac  was  cut 
away,  but  as  it  is  now  thickly  smeared  with  balsam,  it  is  not  possible 
to  say  whether  it  was  removed  during  life  or  after  death.  It  was 
certainly  done  before  the  process  of  embalming  was  complete, 
because  the  wound  is  covered  with  balsam.  The  fact  that  there  is 
a  wound  suggests  that  Merneptah  was  castrated  either  after,  or 
shortly  before  death. 

As  Elliot  Smith  remarks: 

It  seems  unlikely  that  in  so  important  a  matter  as  the  treatment  of  the 
genital  organs,  the  embalmers  should  suddenly  have  broken  away  from  the 
convention  of  their  time  in  the  case  of  Thutmose  II  and  III,  but  not  in  their 
immediate  predecessors  and  successors,  and  again  in  the  succeeding  dynasty 
in  the  case  of  Ramses  II.  The  absence  of  the  genital  organs  in  the  latter 
Pharaoh  seems  to  me  due  to  accidental  circumstances. 

The  scrotum  of  Ramses  V  (1157  B.C.)  was  large  and  baggy  and 
had  been  pushed  back  and  pressed  against  the  perineum,  the  whole 
of  which  was  covered  by  it.  The  great  size  of  the  scrotum  suggested 
that  Ramses  V  suffered  from  hernia  and  possibly  hydrocele.  Imme- 
diately below  Poupart's  ligament,  in  the  right  groin,  there  is  a  large, 
irregularly  triangular,  deep  ulcer  with  thickened  edges.  It  meas- 
ures o .  2  by  1 . 8  cm.,  and  is  covered  by  a  black,  resinous  paste,  which 
prevents  a  minute  examination  of  the  character  of  the  ulcer;  but 
its  situation  suggests  that  it  may  represent  an  open  bubo. 

I  may  add  that  in  no  mummy  that  I  have  examined  have  I  found 
any  evidence  that  the  genital  organs  had  been  interfered  with  after 
death. 

The  only  other  mutilation  that  is  found  frequently  is  the  pier- 
cing of  the  ears  for  the  introduction  of  earrings.    The  fashion  appears 


PATHOLOGICAL  NOTES  ON  ROYAL  MUMMIES  173 

to  have  changed  with  different  kings,  for  whereas  the  perforations  in 
some  are  very  large,  in  others  they  are  quite  small.  In  one  mummy 
of  the  XXIst  Dynasty  (about  1000  B.C.)  that  I  examined,  I  found  the 
lobule  dragged  down  by  the  weight  of  the  earring  and  the  size  of  the 
hole  was  wide  enough  to  allow  the  introduction  of  the  whole  thumb. 

Baldness,  etc. — Among  pathological  conditions  affecting  the 
cutaneous  system  is  baldness,  which  was  found  in  many  of  the  men 
and  not  a  few  of  the  women. 

Queen  Nofritari's  head,  for  instance,  was  bald  on  the  vertex,  and 
Queen  Notmit  also  was  bald.  In  most  cases  the  baldness  is  central; 
occasionally  scattered  patches  are  found  in  the  skull,  showing  that 
it  may  have  been  caused  perhaps  by  some  local  parasitic  disease. 
No  examination  appears  to  have  been  made  for  scalp  parasites. 
Personally,  I  have  not  been  able  to  find  any  in  the  mummies  I  have 
examined,  except,  in  a  few  cases,  the  eggs  of  lice  still  adhering  to 
the  hair. 

It  is  not  clear  to  what  the  baldness  was  due.  It  may  possibly 
have  been  caused  by  the  wearing  of  the  wig,  just  as  the  baldness  of 
the  modern  Egyptian  is  generally  attributed  to  the  wearing  of  the 
tarboush  and  the  turban.  Indeed,  upon  the  lateral  aspects  of  one 
cranium  there  are  large  triangular  depressions  due  to  atrophy  of  the 
outer  surfaces  of  the  parietal  bone,  which  may  have  been  due  to 
some  heavy  wig  or  headgear. 

I  would  point  out,  however,  in  that  connection  that  the  Greek 
priests,  who  never  cut  their  hair,  and  who  never  remove  their 
heavy  headdress  except  at  the  altar,  have  luxuriant  tresses  as  a  rule. 
I  am  therefore  quite  unable  to  account  for  the  baldness  of  old  and 
modern  Egyptians. 

Blackheads  (comedones)  are  not  rare  in  Egyptain  mummies 
and  well  marked  in  the  forehead  of  Ramses  II  (1 225  B.C.) .  His  finger 
nails  exhibit  very  distinct  longitudinal  ridging,  and,  therefore,  the 
king  was  probably  ill  for  some  considerable  time  before  death.  His 
Majesty's  superficial  temporal  arteries  are  even  now  prominent  and 
tortuous,  and  their  walls  undoubtedly  calcareous.  It  will  be 
remembered,  in  this  connection,  that  the  aorta  of  King  Merneptah 
was  calcified,  and  I  have  elsewhere  drawn  attention  to  the  fre- 
quency of  arterial  diseases  in  ancient  Egypt. 


174         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Ulcers  are  not  infrequent.  In  a  woman  buried  in  the  tomb  of 
Amenhotep  II,  there  is  an  elliptical  ulcer  (2.2X1.2  cm.)  with  indur- 
ated edges,  and,  on  the  inner  surface  of  the  same  heel,  a  much  larger 
ulcer  (4 . 4  cm.  in  diameter) .  These  wounds  have  all  the  appearance 
of  ante-mortem  injuries  with  inflammatory  reactions  around  the 
edges.  Elliot  Smith  thinks  it  possible,  however,  that  if  they  were 
done  immediately  after  death  the  action  of  the  salt  bath  on  these  cut 
edges  may  have  given  rise  to  these  appearances.  He  found  in  some 
other  mummies  of  women  the  skin  cut  away  from  the  heel.  If  these 
ulcers  were  not  ante-mortem,  they  were  certainly  done  before  the 
embalming  process  was  complete,  because  the  linen  was  packed  into 
them  and  is  adherent  to  the  bone. 

An  ulcer  the  nature  of  which  is  doubtful  is  to  be  seen  in  the  body 
of  Ramses  IV  (1161  B.C.).  An  elliptical  piece  of  skin  (1.8X0.7  cm.) 
was  cut  off  the  right  side  of  the  penis,  at  the  junction  of  the  glans 
with  the  body  of  the  organ;  this  was  done  probably  just  after  death 
and  before  the  process  of  embalming,  but  it  may  possibly  be  an  ulcer 
with  clean-cut  edges.  An  ulcer  2X1  cm.  is  visible  on  the  back  of 
the  right  scapula,  extending  from  the  posterior  lip  of  the  glenoid 
fossa  to  its  lower  half;  its  edges  are  raised,  and  the  nature  of  the 
lesion  is  doubtful. 

Skin  eruptions. — Maspero  had  already  noted  that  one  of  the 
thighs  of  Queen  Anhapon  (XVIIIth-XIXth  Dynasties)  showed 
"stigmata"  arranged  in  groups  similar  to  those  left  by  lichen. 

A  curious  appearance  of  the  skin  is  seen  also  in  the  mummy  of 
Thutmose  II.  The  skin  of  the  thorax,  shoulders  and  arms,  hands, 
the  whole  of  the  back,  the  buttocks  and  legs  (including  the  feet)  is 
studded  with  raised  macules,  varying  in  size  from  minute  points  to 
patches  a  centimetre  in  diameter.  The  skin  of  the  head  is  not 
affected.  A  condition  precisely  similar  to  this  is  also  found  in  the 
mummy  of  Amenhotep  II,  and  in  a  less  marked  form  in  Thutmose 
III,  and  the  question  is  whether  these  macules  are  due  to  some 
cutaneous  eruption,  or  are  the  result  of  the  action  of  the  preservative 
bath  post-mortem.  On  the  whole,  I  am  inclined  to  look  upon  them 
as  the  manifestation  of  some  disease,  the  nature  of  which  is  not  alto- 
gether clear,  but  the  fact  that  this  irregularity  of  the  skin  occurs  in 
three  successive  Pharaohs  suggests  that  it  may  be  due  to  some  irri- 


PATHOLOGICAL  NOTES  ON  ROYAL  MUMMIES  175 

tant  amongst  the  ingredients  of  the  preservative  materials  employed 
by  the  embalmers  at  that  particular  time. 

Very  different  is  the  eruption  on  Ramses  V,  in  whom  on  the  lower 
surface  of  the  pudenda,  lower  part  of  the  abdominal  wall,  and  on 
the  face  there  is  a  well-marked  pustular  eruption,  which  Professor 
A.  R.  Ferguson  stated  to  be  highly  suggestive  of  smallpox.  This 
rash  is  exactly  similar  to  the  one  which  Professor  Ferguson  and  I 
described  in  our  paper.1  It  may  be  remembered  that  Professor 
Unna  of  Hamburg  criticised  our  view,  and  gave  it  as  his  opinion 
that:  (1)  the  lesions  were  not  characteristic  of  smallpox;  (2)  the 
appearance  of  the  skin  was  due,  not  to  disease,  but  to  soaking  in 
water  (durcknassi) ;  and  (3)  the  bacilli  found  were  of  modern, 
origin. 

I  may  be  allowed  to  answer  shortly  Professor  Unna's  criticisms. 
In  the  first  place,  we  did  not  say  that  the  case  was  one  of  variola,  but 
as  the  title  of  our  paper  stated  we  described  "an  eruption  resembling 
that  of  variola. "  In  our  conclusions  also,  we  wrote  of  the  "probable 
existence  of  smallpox, "  and  throughout  we  spoke  of  lesions  "resem- 
bling" those  of  smallpox.  We  gave  in  full  the  description  of  the 
appearances  which  led  us  to  this  conclusion,  and  although  we  con- 
cluded that  the  bacteria  were  present  at  the  time  of  death,  yet  we 
allowed  that  "they  probably  multiplied  enormously  after  death." 

We  would  remark  that  whereas  our  conclusions  are  based  on  a 
large  number  of  sections,  Professor  Unna's  are  based  on  the  exami- 
nation of  two  sections  only. 

The  mummy  in  question  was  one  of  the  XVIIIth  Dynasty,  which 
had  been  removed  from  its  rock-hewn  cell  at  Deir  el  Bahri,  and 
taken  straight  down  to  Cairo,  together  with  a  large  number  of  other 
mummies.  Deir  el  Bahri  is  one  of  the  dryest  spots  on  earth,  where 
rain  falls  only  about  once  in  every  two  years,  and  where  the  average 
temperature  in  the  tombs  is  2  2°  C .  The  tombs  are  about  three  miles 
in  a  straight  line  from  the  Nile,  and  certainly  not  less  than  a  mile 
distant  from  the  ground  yearly  inundated  by  the  river;  the  floors 
of  the  graves  are  at  least  25  m.  higher  than  the  highest  level  of  the 
water.  In  such  a  tomb  the  mummy  could  not  possibly  have  been 
"  durchnasst, "  at  any  time,  and  other  mummies  from  the  same 

1  Supra,  this  volume,  p.  32. 


176         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

tombs,  now  at  Kasr  el  Aini  Museum  in  Cairo,  are  as  dry  as  a  bone, 
and  none  show  a  rash  similar  to  the  one  described  by  us.1  From 
Deir  el  Bahri  the  mummies  were  taken  to  the  Museum  in  Cairo,  and 
afterwards  to  the  top  floor  of  the  Medical  School,  and  there  again 
it  is  absolutely  impossible  that  they  should  have  been  "  durchnasst. " 
Lastly,  during  the  softening  of  the  object  and  the  preparation  of  the 
sections,  water  was  used  twice  only,  namely,  to  remove  the  alcohol 
from  the  sections  before  staining,  and  to  wash  out  the  superfluous 
stain;  in  both  cases  for  two  minutes  only.  One  can  exclude,  there- 
fore the  theory  that  these  bacteria  belonged  to  the  twentieth  cen- 
tury a.d.,  as  Professor  Unna  suggests. 

The  discovery  of  these  bacilli  is  not  a  solitary  find,  for  I  have 
stained  bacteria  in  material  dating  from  previous  ages,  e.g.,  in  the 
intestinal  contents  of  a  body  of  the  Xlth  Dynasty  (2000  B.C.),  in 
the  sand  of  brick  of  Karnak  Temple  (which  sand,  let  it  be  said  by 
the  way,  was  quite  sterile  when  inoculated  into  gelatine  or  bouillon) , 
in  the  mud  with  which  the  internal  cavities  of  mummies  were  packed, 
in  the  lungs  of  mummies  of  the  XVIIIth,  XXIst,  XXIId  Dynas- 
ties, and  of  Greek,  Roman,  and  Coptic  times,  in  the  kidneys  of 
mummies  of  the  XXIst  Dynasty,  in  the  livers  of  mummies  of  the 
XXIst  Dynasty  and  of  Coptic  times,  etc. 

All  the  mummies  were  unrolled  by  me,  and  were  perfectly  dry. 
Several  of  them  had  been  treated  with  hot  gum,  of  which  they  con- 
tained considerable  quantities. 

After  all,  it  is  not  very  remarkable  that  bacteria  like  other  vege- 
table tissues  should  be  recognisable  after  several  thousand  years. 
I  examined  during  the  last  two  years  sixteen  bodies  of  Coptic  times, 
in  which  the  garlands  of  flowers  round  the  neck,  although  dried  up, 
were  in  a  perfect  state  of  preservation.  I  found  that  the  garments 
covering  these  bodies  were  simply  beautiful,  with  well-preserved 
coloured  patterns;  they  even  stood  washing  with  soap  and  water. 
There  are  now  about  one  hundred  specimens  of  these  embroidered 
garments,  representing  most  diverse  objects,  in  the  Alexandria 
Museum. 

1  Since  writing  the  above,  I  have  found  another  dried  body,  also  from  Upper 
Egypt,  which  shows  very  much  the  same  appearance  as  that  described  by  Dr.  Ferguson 
and  myself.     I  hope  to  publish  something  more  about  it  later  on. 


PATHOLOGICAL  NOTES  ON  ROYAL  MUMMIES  177 

Linen  bandages  also,  dating  from  the  XXVIIth  Dynasty,  look 
almost  as  if  they  had  just  come  from  the  maker,  and  I  have  in  my 
private  collection  a  beautiful  specimen  of  Coptic  embroidery  which 
might  have  been  made  only  a  few  years  ago.  The  fringe  is  perfect, 
and  the  fine  thread  used  for  stitching  the  hem  is  very  resistant  and 
might  easily  be  threaded  and  used  again.  Similarly,  in  some  micro- 
scopical sections  the  nuclei  of  the  cells,  e.g.,  in  the  skin  and  liver,  can 
be  recognized  still.  There  is  no  reason,  therefore,  why  very  resist- 
ant bacteria  should  not  be  seen  now. 

Lesions  of  the  teeth. — Very  various  also  are  the  lesions  of  the 
teeth. 

In  an  unknown  woman,  perhaps  the  princess  Meritamon(XIIth- 
XIII th  Dynasties,  about  1900  B.C.),  all  the  teeth  of  the  upper  jaw 
were  carious,  with  the  exception  of  the  canine  and  third  molar;  and 
the  first  and  second  molars  were  reduced  to  mere  carious  stumps. 
An  old  woman  called  Houttimihou  (XVIIIth  Dynasty,  about  1400 
B.C.)  had  a  carious  first  molar  and  an  alveolar  abscess  at  the  root  of 
the  first  molar  tooth  near  it.  Amenhotep  III  had  teeth  moderately 
worn.  On  the  right  side,  though  not  on  the  left,  the  teeth  of  both 
upper  and  lower  jaws  were  thickly  encrusted  with  tartar,  and  there 
had  been  an  extensive  abscess  below  the  right  incisors,  and  a  smaller 
one  above  the  right  upper  canine.  The  upper  incisor  teeth  had  been 
lost  before  the  death  of  Amenhotep,  and  the  alveolar  process 
absorbed  in  part;  the  right  upper  lateral  incisor  had  been  recently 
lost,  for  its  alveolus  and  the  perforation  (facial)  of  a  small  alveolar 
abscess  were  still  present.  There  is  also  evidence  of  suppuration 
around  the  anterior  lateral  root  of  the  left  lower  first  molar. 

It  appears  to  me  that  as  caries  of  teeth  is  not  mentioned,  this 
loss  of  teeth  and  the  multiple  alveolar  abscesses  were  probably  due 
to  pyorrhoea  alveolaris.  It  is  very  strange  that  the  lesions  of 
periodontal  disease,  which  are  certainly  very  common  from  pre- 
dynastic  to  present  times,  should  hardly  have  drawn  any  attention 
as  yet. 

The  above  quotations  show  conclusively  how  much  the  ancient 
Egyptains,  even  of  the  best  circles,  suffered  from  their  teeth.  I 
have  already  in  other  papers  drawn  attention  to  the  fact  that  many 
dental  lesions  could  have  been  remedied  by  very  simple  operations, 


178  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

which,  however,  do  not  appear  ever  to  have  been  undertaken.  It 
shows  conclusively  that  the  stories  copied  from  textbook  to  textbook 
about  the  wonderful  knowledge  of  dentistry  possessed  by  old 
Egyptians  are  not  borne  out  by  facts.  It  is  impossible  to  believe 
that  Amenhotep  III  would  have  endured  the  agony  which  he  must 
have  gone  through  if  the  court  dentist  had  known  how  to  pull  out  a 
tooth. 

Talipes-  equino-varus. — A  well-marked  deformity  was  that  of 
Siptah  (1209  B.C.)  whose  left  foot  shows  the  characteristic  deformi- 
ties of  talipes  equino-varus.  This  malformation  is  one  which  was 
known  to  have  existed  in  ancient  Egypt,  for  Miss  Murray1  in  her 
valuable  monograph  has  described  and  figured  it.  On  the  walls  of 
Egyptian  monuments  also  representations  of  club-footed  males  and 
females  have  been  found,  and  I  have  figured  some  of  them  in  a 
previous  paper.2  These  malformed  people  shared  with  dwarfs,  if 
not  the  affection,  at  any  rate  the  interest  of  kings  and  rich  people, 
as  they  often  formed  part  of  some  large  household. 

The  facts  enumerated  above  form  an  important  addition  to  our 
knowledge  of  the  diseases  of  ancient  Egyptians,  and  seeing  how 
much  has  been  learned  from  the  examination  of  a  few  mummies, 
one  cannot  help  regretting  that,  in  the  past,  much  material  should 
have  been  wantonly  destroyed.  Let  us  hope  that  this  waste  may 
be  diminished  in  the  future. 

1  Margaret  Murray,  The  Tomb  of  Two  Brothers. 

-  "On  Dwarfs  and  Other  Deformed  Persons  in  Ancient  Egypt,"  Bulletin  de  la 
Societe  Archeologique  d'Alcxandrie,  No.  13  (1911),  p.  1. 


A  TUMOUR   OF   THE   PELVIS   DATING  FROM   ROMAN 
TIMES  (250  A.D.)  AND  FOUND  IN  EGYPT1 

{Journal  of  Pathology  and  Bacteriology,  Vol.  XVIII  [1914]) 

The  bone  which  forms  the  subject  of  this  note  was  found  by  us 
in  the  catacombs  of  Kom  el  Shougafa,  in  Alexandria. 

The  skeletons  in  the  catacombs  undoubtedly  date  fromEgyptian- 
Roman  times,  and,  most  probably,  from  the  middle  of  the  third 
century  after  Christ,  or  from  some  time  before  that  date.  The 
specimen  in  question  was  discovered  among  a  number  of  human 
bones,  in  a  grave  which  had  been  thoroughly  rifled  some  time  ago. 
The  other  bones  were  heaped  up  in  utter  confusion  at  one  end  of  the 
grave,  and  they  were  in  such  a  bad  state  that  it  was  impossible  to 
gather  together  the  rest  of  the  skeleton  to  which  this  specimen 
belonged. 

The  grave  had  been  opened  for  some  time  and  was  very  damp, 
and  all  the  bones  had  a  tendency  to  break  to  pieces,  even  when 
treated  with  the  greatest  care.  Often  they  were  so  fragile  that  the 
only  method  of  preserving  them  was  to  plunge  them  into  melted 
paraffin  at  55°  C.;  when  all  the  air  bubbles  had  escaped  (ten  to 
thirty  minutes) ,  the  paraffin  was  allowed  to  run  off.  Care  was  taken 
to  dry  them  thoroughly  before  they  were  placed  in  the  paraffin,  all 
adherent  sand  and  other  foreign  bodies  being  removed  with  a  soft 
brush.  The  specimens  so  treated  could  then  be  handled  with  per- 
fect safety. 

DESCRIPTION   OF    SPECIMEN   FOUND 

We  shall  compare  the  bone  to  be  now  described  with  a  control  one, 
approximately  of  the  same  size  and  dating  from  the  same  period. 

The  tumour  occupies  the  right  os  innominatum  (Plate  XLV,  Fig.  1)  and 
affects  particularly  the  ischium  and  lower  portion  of  the  ilium.  The  os  pubis 
is  apparently  normal. 

Maximum  vertical  length,  from  iliac  crest  to  tuber  ischii  ...21.6 

Maximum  vertical  length  of  control 21.4 

Maximum  width  from  angle  of  pelvis  to  spine  of  ischium 12.5 

'  This  paper  was  written  with  J.  Graham  Willmore  as  junior  author. 


180         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Posterior  portion  of  ilium,  including  articular  surface,  has  been  broken 
away  along  an  irregular  line  drawn  on  antero-internal  surface,  from  the  angle 
of  great  sacro-sciatic  notch  to  a  point  on  iliac  crest  corresponding  to  middle  of 
insertion  of  quadratus  lumborum.  On  postero-external  surface  a  large  spike 
of  bone,  owing  to  fracture  being  obliquely  directed  from  before  and  outwards 
to  behind  and  inwards,  projects  nearly  as  far  as  postero-inferior  spine.  Spine 
of  ischium  is  also  broken  away.  Thus,  the  great  sacro-sciatic  notch,  viewed 
from  behind,  appears  far  more  nearly  complete  than  it  does  when  seen  from 
interior  of  pelvis.  Broken  surface  of  bone  is  cancellous  and  apparently  healthy, 
though  perhaps  rather  more  spongy  than  normal. 

Ilium  greatly  thickened  throughout.  Crest  smooth  and  rounded,  measures 
at  its  thickest  1.9  cm.,  and  at  its  thinnest  1.5  cm.  across.  Control  pelvis 
shows  evidence  of  osteo-arthritis,  with  thickening  and  roughening  of  crest, 
yet  its  corresponding  measurements  are  1.7  and  0.75  cm. 

cm. 
Maximum  vertical  length  of  ilium,  from  crest  to  upper  border 

of  acetabulum 10. o 

Corresponding  measurement  in  control 14 .4 

Maximum  horizontal  measurement,  from  broken  area  near 

superior-posterior  to  superior-anterior  spine 12.5 

Control 13.0 

From  anterior-superior  to  anterior-inferior  spine 4.0 

Control 2.3 

Depth  of  notch  between  the  two 0.7 

Control 0.8 

Thickness  of  bone,  from  a  point  just  above  acetabulum 
externally  to  a  little  above  bony  insertion  of  the  psoas 

parvus  internally 2.3 

Control 2.1 

ACETABULUM 

The  cavity  of  the  acetabulum  is  healthy: 

cm. 
Maximum  vertical  diameter 5 

Control S 

Maximum  horizontal  diameter 5 

Control S  •  S 

Maximum  depth 2.4 

Control 3-7 

In  the  control  pelvis  there  is  a  good  deal  of  osteo-arthritis,  with  lipping  of 
the  acetabular  brim  and  thinning  of  the  floor  of  the  cavity. 

From  anterior-superior  spine  to  angle  of  os  pubis 15.7 

Control r3.s 


TUMOUR  OF  THE  PELVIS  181 

The  specimen  was  sawn  across  horizontally  through  middle  of  acetabulum, 
from  just  above  the  origin  of  the  ischial  spine  behind  to  point  of  junction  of 
horizontal  ramus  of  os  pubis  with  ilium  in  front. 

The  obturator  foramen  is  left  intact. 

The  line  of  section  passes  through  the  main  mass  of  the  tumour  (see 
Plate  XL VI,  Figs.  2  and  3).  The  body  of  the  ischium  in  particular  is  seen  to 
be  enormously  distended. 

cm. 
a)*  The  maximum  antero-posterior  diameter  of  tumour,  as 
seen  on  the  upper  surface  of  the  lower  segment,  measures . .   7.0 

b)  The  maximum  traverse  diameter 5.1 

Control i.2 

c)  Maximum  vertical  length  approximately 11.0 

Control  identical. 
From  centre  of  the  acetabulum  transversely  across  to  the 

inner  surface  of  the  pelvis 2.5 

Control 0.1 

From  the  acetabulum  across  to  the  obturator  groove,  the 

thinnest  part  of  the  tumour,  is 1.3 

Control 0.3 

*  Line  (a)  (7  cm.)  is  taken  from  posterior  border  of  body  of  the  ischium  to  its  junction  with  horizonta 
ramus  of  the  os  pubis.  Ramus  of  pubis  is  spongy,  but  while  there  is  no  very  definite  wall  between  the  two, 
the  process  seems  to  have  stopped  short  at  this  point,  i.e.,  the  obturator  groove. 

Line  (6)  (5.1  cm.)  is  taken  from  posterior  brim  of  the  acetabulum  to  the  inner  surface  of  the  bone 
just  above  the  origin  of  the  ischial  spine. 

Line  (c)  is  taken  from  1 .0  cm.  above  lower  border  of  ischial  tuberosity,  which  does  not  appear  to  be 
involved,  to  a  point  1 .0  cm.  above  upper  border  of  acetabular  brim. 

It  will  thus  be  seen  that  the  tumour  has  encroached  upon  the  cavity  of  the 
acetabulum,  while  in  the  control,  in  connection  with  the  osteo-arthritis,  there 
seems  to  have  been  some  rarefying  process  at  work  which  has  unduly  thinned 
the  acetabular  floor  and  rendered  its  cavity  deeper  than  normal. 

cm. 
From  a  point  on  the  outside  just  below  acetabular  margin  to 
a  corresponding  point  on  inner  surface  of  body  of  ischium .  .  4.9 

Control 2.8 

From  the  posterior  border  of  the  ischium  to  most  prominent 
part  of  anterior  margin  (i.e.,  about  the  middle  of  the 

posterior  border  of  the  obturator  foramen) 6.0 

Control 3.6 

The  tumour  does  not  appear  to  involve  either  the  tuberosity  or  the  ramus 
of  ischium.  A  line  drawn  from  the  posterior  border  of  the  acetabular  notch 
to  the  lower  border  of,  and  at  right  angles  to,  the  ramus  of  the  ischium,  meas- 
ures only  5.4  cm.  as  compared  with  5.8  cm.  in  the  control;    whereas  a  line 


1 8  2         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

drawn  from  the  same  point — i.e.,  the  acetabular  notch — to  the  nearest  part  of 
obturator  foramen  measures  3  cm.,  as  compared  with  1.2  cm.  in  control. 

The  obturator  foramen  is  greatly  encroached  upon;  it  is  crescentic  in  out- 
line, the  two  horns  pointing  backwards  and  upwards,  and  backwards  and  down- 
wards, the  enlargement  forward  of  body  of  ischium  being  most  marked  between 
these  horns.  The  transverse  breadth  of  the  foramen  at  its  middle  part  is  only 
2  cm.  as  compared  with  4.5  cm.  in  the  control;  longitudinally,  it  measures 
5.5  cm.  as  compared  with  5.3  cm.  in  the  control.  Thus,  it  is  evident  that 
the  tumour,  starting  probably  in  the  body  of  the  ischium,  has  spread  forwards 
so  as  to  encroach  on  the  obturator  foramen,  and  also  sideways,  expanding 
particularly  within  the  true  pelvis.  The  expansion  upwards,  therefore,  has 
not  been  so  great,  and  forwards  and  downwards  it  has  been  still  less. 

Examined  from  inside  the  true  pelvis,  the  bone  presents  a  rounded,  polished 
surface,  bulging  into  the  pelvic  cavity,  with  seven  grooves  on  it  which  converge 
into  one  large  groove  passing  backwards  and  outwards  under  ischial  spine.  On 
the  inner  side  these  radiate  forwards  and  spread  out  fanwise,  the  uppermost 
vertically  upwards  for  about  3  cm.  in  front  of  the  ischial  spine;  the  second 
towards  the  ileo-pectineal  line;  the  third,  indistinct,  is  lost  on  the  bulging 
surface  of  the  tumour;  the  fourth,  very  well  defined,  deep  and  narrow  (0.5  cm.) 
passes  forwards  and  slightly  upwards  and  outwards  over  the  body  of  the 
tumour  and  apparently  leads  directly  into  the  acetabulum.  The  fifth  (1.5  cm. 
broad  in  its  widest  part)  is  separated  from  the  preceding  by  a  well-marked 
ridge  of  bone  0.6  cm.  broad,  curves  upwards  and  outwards  almost  parallel  to  the 
preceding,  and  is  lost  near  the  posterior  margin  of  the  obturator  foramen.  The 
sixth,  indistinct,  runs  to  the  lower  angle  (or  horn)  of  the  obturator  foramen. 
The  seventh,  well  defined,  pursues  the  usual  course  of  the  groove  for  the  pubic 
vessels  and  nerve.  It  is  probable  that  all  these  grooves  were  formed  by 
enlarged  blood  vessels. 

On  section  (Plate  XL VI,  Figs.  2  and  3)  the  tumour  is  seen  to  consist  of 
compact  bony  tissue  with  numerous  cavities  interspersed.  One  of  them, 
situated  near  the  inner  surface,  extends  from  in  front  of  the  centre  of  the 
acetabulum  to  near  the  origin  of  the  ischial  spine,  and  is  of  considerable  size. 
It  measures  2.1  cm.  in  length,  1  cm.  in  breadth,  and  2  cm.  (approximately) 
in  depth.  The  cavities  are  in  some  places  smooth  and  shining,  in  others 
they  show  numerous  fine  trabeculae  which  branch  and  project  into  the  interior 
and  form  a  delicate  honeycomb.  These  trabeculae  are  very  soft  and  friable, 
even  after  treatment  with  paraffin. 

The  cavities  above  mentioned  have  no  obvious  communication  with  the 
exterior,  and  in  no  way  resemble  those  produced  by  osteophagous  insects, 
samples  of  whose  work  are  sometimes  to  be  seen  on  the  surface  of  certain  bones; 
moreover,  they  are  situated  in  the  midst  of  hard  and  massive  compact  tissue, 
not  in  the  cancellous  tissue. 

Microscopically,  nothing  new  was  ascertained,  chiefly  because  the  sections 
proved  exceedingly  unsatisfactory. 


PLATE  XLV 


TUMOUR  OF  THE  PELVIS 


We  are  here  in  presence  of  a  tumour  which  has  started  in  the 
cancellous  tissue  of  the  pelvis.  Its  growth  has  caused  (i)  a  very 
marked  expansion  of  the  bone,  noticeable  chiefly  in  the  body  of  the 
ischium  and  ilium ;  (2)  great  deformation  of  the  obturator  foramen; 
and  (3)  it  has  encroached  to  some  extent  on  the  acetabulum. 
Judging  from  the  numerous  grooves  on  the  surface,  it  is  very 
probable  that  this  tumour  was  highly  vascular,  and  that  very  soon 
it  would  have  involved  the  more  superficial  parts  of  the  bone,  which 
had  remained  intact  so  far. 

The  exact  nature  of  the  tumour  must  remain  uncertain.  It  is 
clear,  however,  that  the  swelling  was  not  due  to  any  of  the  infective 
agents,  such  as  tubercle,  syphilis,  actonomycosis,  etc.  From  the 
fact  that  the  larger  part  of  the  tumour  is  solid,  secondary  carcinoma 
can  also  be  excluded. 

Taking  into  consideration  the  fact  that  the  swelling  is  deeply 
seated,  partly  solid  and  partly  cystic,  and  had  evidently  been  grow- 
ing fast,  we  are  of  opinion  that  the  tumour  was  most  probably  an 
osteosarcoma,  of  which  the  bony  substance  has  resisted  the  effects 
of  time,  whereas  its  soft  parts  have  disappeared. 

It  is  not  possible,  however,  to  say  whether  the  tumour  was 
primary  or  secondary. 

DESCRIPTION  OF  PLATES  XLV-XLVI1 

PLATE   XLV 

Fig.  1. — Tumour  in  situ. 

PLATE   XLVI 

Figs.  2  and  3. — Section  through  the  tumour. 

1  The  blocks  have  been  prepared  from  paintings  by  M.  A.  Cooper.  The  drawings 
are  exactly  natural  size. 


A    PATHOLOGICAL    SPECIMEN    DATING    FROM    THE 
LOWER  MIOCENE  PERIOD1 

The  typical  lesions  of  chronic  joint  disease  have  been  discovered 
in  European  skeletons  dating  from  remote  antiquity,  as,  for  instance, 
in  the  skeleton  of  a  man  from  the  Quaternary  station  of  Raymonden, 
a  village  situated  in  the  commune  of  Chancelade,  seven  kilometres 
to  the  northeast  of  Perigueux.  This  skeleton  now  occupies  a  place 
of  honour  in  the  museum  of  that  town,  and  its  anatomical  and 
pathological  peculiarities  have  been  fully  described  by  a  competent 
observer.2 

The  bones  are  those  of  a  man  who  was  about  fifty  years  old  at 
the  time  of  death,  and  who,  long  before  his  end,  had  suffered  from 
an  extensive  fracture  of  the  right  temporal  region,  which  had  com- 
pletely healed.  All  the  maxillary  teeth  had  been  lost  during  life. 
The  arthritic  lesions  consist  of: 

i.  Very  wide  enlargement  of  the  cos  to-transverse  articula- 
tion of  one  rib,  with  articular  exostosis  typical  of  chronic  osteo- 
arthritis. 

2.  Enlargement  of  the  transverse  diameter  of  the  glenoid  cavity 
of  the  right  scapula,  of  which  only  fragments  remain.  This  enlarge- 
ment was  probably  due  to  osteo-arthritis  of  the  humero-scapular 
articulation;  few  traces  of  periarticular  pathological  osseous  forma- 
tions are  noticeable  round  this  articulation,  and  the  head  of  the 
right  humerus  presents  the  characteristic  lesions  of  dry  arthritis. 
The  articular  surface  of  the  bone  is  encircled  by  an  osteophyte 
cushion,  o  .009  m.  wide  and  o  .008  m.  thick,  and  the  many  vascular 
orifices  opening  on  it  show  clearly  that  the  movements  of  the  joint 
had  been  affected  by  pathological  changes  in  the  cartilage,  which 
probably  had  been  completely  absorbed  during  life. 

1  This  paper  first  appeared  as  an  appendix  to  a  work  by  R.  Fourtau,  Contribution 
d  V etude  des  vertebres  miocenes  de  V&gyptc,  which  was  issued  by  the  Geological  Sur- 
vey Department  of  Egypt,  1920. 

2  L.  Testut,  "Recherches  anthropologiques  sur  le  squelette  quaternaire  de  Chance- 
lade, Dordogne,"  Extrait  du  Bulletin  de  la  Societe  d' Anthropologic  de  Lyon. 


LOWER  MIOCENE  SPECIMEN  185 

The  occurrence  of  osteo-arthritis  in  prehistoric  people  has  been 
known  for  a  long  time,  and  in  188 1  J.  le  Baron1  wrote  an  interesting 
memoir  on  this  subject.  Since  then  evidence  proving  that  this 
disease  was  very  common  during  the  Stone  Age  has  been  gradually 
accumulating.  In  the  Neolithic  burials  of  Vendrest  in  the  Vendee, 
for  instance,  Baudouin2  found  specimens  of  osteo-arthritis  of  the 
cervical  vertebrae,  atlas,  atloaxoid  articulations,  knee-joint,  ribs, 
lower  end  of  the  fibula,  third  right  metatarsal,  first  phalanx  of  the 
toes,  first  phalanx  of  the  right  hallux,  and  second  phalanx  of  the 
toes  and  probably  of  the  vertebrae  also. 

The  Neolithic  ossarium  of  Bazoges  en  Pareds  (Vendee)  yielded 
to  the  same  observer  human  bones  with  typical  osteo-arthritic 
lesions  of  the  fibula  (four  cases),  patella,  ulna,  clavicle,  axis,  hallux 
(three  cases),  phalanges  of  foot,  etc.3 

The  museums  of  the  Anthropological  School  and  of  the  Jardin 
des  Plantes,  Paris,  and  many  of  the  interesting  anthropological 
collections  in  provincial  French  towns  contain  numerous  anatomical 
specimens  showing  that  for  thousands  of  years  many  inhabitants 
of  Gaul  were  crippled  by  osteo-arthritis. 

In  England  also  the  disease  appeared  very  early.  The  pre- 
historical  remains  of  Caithness4  show  pathological  lesions  probably 
due  to  osteo-arthritis.  In  one  case  exostoses  were  discovered  on  the 
front  spaces  of  the  pubic  bones  near  the  symphysis,  and  on  the  ilium 
and  sacrum  in  the  region  of  the  synchondroses.  It  was  certainly 
prevalent  during  the  Bronze  Age.5  An  old  man  found  near  Broad- 
stairs,  for  instance,  suffered  from  "osteitis  of  the  vertebral  column, 
pelvis,  and  shoulder  girdle, "  and  some  of  the  vertebrae  of  a  middle- 
aged  male  Jute  from  a  neighbouring  grave  were  ankylosed  by 
spondylitis. 

1  J.  Ie  Baron,  Lesions  osscuses  de  I'homme  prehislorique  en  France  et  en  Algerie, 
these  de  Paris,  1881  (8vo).  See  also  J.  le  Baron,  "Sur  les  lesions  osseuses  prftusto- 
riques,"  Bulletin  de  la  Sociele  d' Anthropologic  de  Paris,  IV  (1881),  596. 

2  Marcel  Baudouin,  Diseases  of  Bones. 

3  Baudouin,  "Les  affections  osseuses  decouvertes  dans  l'ossuaire  neolithiquc 
de  Bazoges  en  Pareds  (Vendue),"  Arch.  Prov.  de  Chirurgie,  Vol.  XXIII  (1914), 
No.  1,  p.  22. 

*  Samuel  I.aing,  Prehistoric  Remains  of  Caithness,  with  notes  by  Th.  H.  Huxley. 
'  !•'.  G.  Parsons,  "On  Some  Bronze  Age  and  Jutish  Bones  from  Broadstairs,'' 
Journal  of  the  Anthropological  Institute  of  Great  Britain  and  Ireland,  XLIII  (1913),  S5°. 


186         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  Germans  of  pre-Roman  days  did  not  escape.  The  long 
bones  of  a  skeleton  from  a  tumulus1  at  Klein  Asbergle-Ludwigsburg, 
were  disfigured  by  excrescences  typical  of  arthritis  chronica  defor- 
mans. Rough,  warty,  comblike  outgrowths  were  obvious  in  the 
posterior  side  of  the  femur  and  humerus,  especially  in  the  neighbour- 
hood of  the  joints  and  along  the  muscular  insertions. 

Arthritis  deformans  has  been  described  in  a  series  of  Swedish 
skeletons  dating  from  Neolithic  times.2  It  was  prevalent  in  Scan- 
dinavia at  the  time  of  the  Vikings  and  a  well-marked  case  was  dis- 
covered3 in  a  Viking  ship  dating  from  the  tenth  century  a.d.  The 
subject  of  the  disease  was  an  old  man  about  fifty  years  old. 

It  is  very  interesting  to  note  that  also  by  the  excavation  of  the  tumulus 
where  our  last  viking  ship,  the  Osberg-ship,  was  found  in  the  year  1904,  there 
were  also  removed  from  the  ship  fragments  of  a  female  skeleton  (also  probably 
fifty  years  old)  which  was  showing  traces  of  arthritis  deformans.  I  have  also 
by  examination  of  many  hundreds  of  skeletons  from  the  anatomical  collections 
in  Lund  and  Upsala  (Sweden)  seen  several  specimens  with  the  same  disease. 4 

Arthritis  of  prehistoric  Danish  bodies  also  has  been  described,5 
and  was  very  common,  as  the  majority  of  adult  skeletons  are 
attacked. 

Elliot  Smith  and  Wood  Jones6  showed  the  great  frequency  of 
osteo-arthritis  among  ancient  Egyptians  in  Nubia  and  Upper  Egypt. 
Later  on,  Rietti  and  I7  described  many  specimens  dating  from  the 

1  H.  von  Holder,  "  Untersuchungen  iiber  die  Skelettfunde  in  den  vorrbmischen 
HugelgraberaWiirttembergsundHohenzollerns,''i7««rf6mc/z;ea!/i5c/jitia6£;;j,II  (1895). 

2  C.  M.  Furst,  Skelettfunde  aus  Steinzcitgrabcrn  in  Nerike,  nebst  einigen  iiber 
Stcinaltersvolkes  Krankheiten  und  Verletzungen,  Fernwannen,  1914.  See  also  Mittcil- 
ungen  zur  Geschichte  der  Medizin  und  der  Naturwisscnschaflcn,  Vol.  XIII,  No.  4,  p.  5 1 5 . 

3  N.  Nicoloysen,  The  Viking  Ship  Discovered  at  Golhsladt  in  Norway,  Christiania, 
1882. 

«  Private  letter  from  Dr.  Fredrik  Gron  of  Christiania. 

s  H.  A.  Nielsen,  Ref.  in  Mitteiluhgen  zur  Geschichte  der  Medizin  und  Naturwissen- 
schaften,  IV,  377. 

6  G.  Elliot  Smith  and  F.  Wood  Jones,  Archaeological  Survey  of  Nubia,  Report  for 
1907-8,  Vol.  II,  "Report  on  the  Human  Remains." 

'M.  Armand  Rufier  and  Arnoldo  Rietti,  "On  Osseous  Lesions  in  Ancient 
Egyptians,"  Journal  of  Pathology  and  Bacteriology,  XVI  (1912),  439. 

M.  A.  Rufier,  "Studies  in  Paleopathology  in  Egypt,"  ibid.,  XVIII  (1913),  149- 
"Notes  on  Two  Egyptian  Mummies,"  Bulletin  de  la  Sociele  Archeologique  d'Alcxandrie, 
No.  14  (1912),  p.  1.  "Note  on  the  Diseases  of  the  Sudan  and  Nubia  in  Ancient 
Times,"  Miiteilungen  zur  Geschichte  der  Medizin  und  Nalurwissenschaften,  Vol.  XIII 
(1914),  No.  4. 


LOWER  MIOCENE  SPECIMEN  187 

Meroitic  kingdom  of  the  Sudan,  and  Greek  and  Roman  Alexandria 
and  early  Christian  Upper  Egypt. 

The  cave  bear,  Ursus  spelaeus,  lived  in  the  caves  before  man. 
It  is  found  in  the  Lower  Palaeolithic  epoch  and  is  occasionally 
though  rarely  met  with  during  the  Reindeer  period,  especially  at 
Bassompuy  and  in  many  Solutrean  and  pre-Solutrean  strata.  The 
Herm  grotto  in  the  Ariege  contained  very  many  skeletons  of  this 
animal.  Drawings  of  the  cave  bear  adorn  a  slate  plate  discovered 
in  an  Upper  Palaeolithic  stratum,  and  the  wall  of  a  grotto  at  Com- 
barelles  (Dordogne). 

This  enormous  beast,  when  erect,  sometimes  measured  as  much 
as  2 . 5,1  m.  and  though  herbivorous  chiefly,  probably  fed  on  carrion 
also,  and  on  game  now  and  then. 

The  naturalist  Saak,2  in  1824,  collected  from  the  Sundvich  caves, 
near  Iserlohn,  many  bones  of  Ursus  spelaeus  exhibiting  pathological 
changes  which  were  studied  afterwards  by  Noggerath,3  and  espe- 
cially by  von  Walther.4  The  latter  correctly  described  the  lesion  of 
osteo-arthritis  and  spondylitis,  and  the  investigations  of  Virchow  on 
Hohlengicht,  which  are  always  quoted,  were  not  published  till  more 
than  fifty  years  afterwards. 

The  last  student  of  this  disease  in  cave  bears  has  described  the 
following  pathological  lesions  :5 

1.  Bear  A. — Seventh  cervical  vertebra.  Large  osteophyte  of  the  body. 
Osteitis  of  transverse  processes. 

2.  Bear  B. — Dorsal  osteophyte  of  posterior  part  of  body  en  bourrelet. 

3.  Bear  C. — Dorsal  vertebra.  Posterior  region  of  thorax.  Right  and  left 
osteophytes  of  the  inferior  face  of  the  body. 

4.  Bear  D. — Dorsal  vertebra.  Osteophyte  of  body  localized  on  the  left 
side. 

5.  Bear  E. — Ankylosis  of  two  lumbar  vertebrae.  Median  osteophyte  of 
body.     Vertebral  superior  and  inferior  osteo-arthritis.     Superior  ankylosis. 

'  Hugo  Obermaier,  Dcr  Mensch  allcr  Zeilen,  p.  91. 

1  I  wan  Bloch,  Dcr  Ursprung  der  Syphilis,  p.  320. 

J  NOggerath,  Archivfiir  die  gesamte  Naturlchre,  Vol.  II  (1824),  No.  3,  p.  323. 

4  Fr.  von  Walther,  "Ueber  das  Altertum  der  Knochenkrankheiten,"  Journal  der 
Chirurgir,  und  Augenheilkunde,  VIII  (1825),  1. 

'•  Marcel  Baudouin,  "La  spondylite  deformante  a  l'fipoque  neolithique  etchez  les 
animaux  prfihistoriques,"  Arch.  Prov.  de  Chiriirgic,  101 2,  p.  274. 


188         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

6.  Bear  F. — Inferior  ankylosis  of  two  successive  lumbar  vertebrae.  Cen- 
tral region.  Median  osteophyte  of  the  body  encroaching  on  neighbouring 
bodies.     Inferior  and  posterior  vertebral  osteo-arthritis.     Inferior  ankylosis. 

The  osteo-arthritic  lesions  of  the  vertebrae  of  cave  bears  which, 
thanks  to  the  kindness  of  Professor  Cartailhac,  I  had  an  oppor- 
tunity of  examining  in  the  museum  of  Toulouse,  are  identical  with 
those  of  spondylitis  deformans  in  early  or  modern  man.  The  lip- 
ping of  the  vertebrae,  the  osteophytes  on  the  borders  of  the  vertebral 
bodies,  the  pathological  changes  in  the  articulating  surfaces,  and  the 
ankylosis  resulting  from  these  various  lesions,  all  are  typical  of 
spondylitis  deformans.  Pathological  changes  in  the  teeth  attribut- 
able to  pyorrhoea  were  present  in  one  skull  only,  in  which  the  fangs 
of  the  molars  and  premolars  on  one  side  were  partly  bare. 

A  tibio-tarsal  articulation  of  a  Bos  primigenins  in  the  same 
museum  showed  well-marked  signs  of  periarthritis.  The  tibia  of  a 
cave  hyena  in  the  museum  at  Foix,  in  the  Pyrenees,  shows  severe 
osteo-arthritic  lesions,  and  I  have  seen  similar  specimens  in  several 
other  provincial  museums  of  France. 

Spondylitis  was  not  uncommon  in  the  sacred  monkeys  of  the 
ancient  temples  near  Thebes.  The  large  articulations  of  a  young 
Cynocephalus,  for  instance,1  were  surrounded  by  huge  osseous 
"vegetations,"  and  several  dorsal  and  lumbar  vertebrae  of  this 
animal  were  ankylosed.  Six  vertebrae  of  the  lumbar  region  of 
another  monkey  were  similarly  affected,  the  three  lower  lumbar 
vertebrae  forming  a  solid  block,  owing  to  the  ossification  of  the 
anterior  vertebral  ligament  and  neighbouring  fibrous  tissue.  The 
layer  of  new  bone,  hard  as  ivory,  was  from  0.003  to  0.004  m.  thick, 
and  extended  as  far  as  the  transverse  processes.  A  large  number 
of  the  lumbar  and  caudal  vertebrae  of  another  monkey  also  were 
ankylosed.2  Without  hesitation  this  pathological  condition  has 
been  attributed  to  life  in  cold  and  humidity,  regardless  of  the  fact 
that  the  rainfall  at  Thebes  is  practically  nil,  and  the  average  tem- 
perature of  the  cold  and  sunless  temples  is  200  C. 

Sheep  and  oxen  were  not  immune  in  ancient  Egypt.3  The  last 
dorsal  and  four  first  lumbar  vertebrae  of  a  sacred  sheep,  for  instance, 

1  Lortet,  La  faune  momifiec  dc  I  'ancicnne  Egypte,  Serie  II,  p.  2. 

2  Ibid.,  Serie  III,  p.  2.  3  Ibid.,  p.  9. 


LOWER  MIOCENE  SPECIMEN  189 

were  so  firmly  ankylosed  that  all  movements  must  have  been 
extremely  difficult.  The  vertebral  ligament,  ossified  on  the  inter- 
nal ( ?)  side,  was  from  o .  003  to  o .  005  m.  thick.  No  trace  of  ulcera- 
tion existed.  The  pelvic  bones  of  a  Bos  africanus  also  were  deformed 
by  numerous  vegetations  and  exostoses. 

The  facts  just  related  show  clearly  that,  from  the  earliest  times, 
osteo-arthritis  attacked  men  and  animals  living  under  the  most 
different  climates  and  conditions  and  eating  most  dissimilar  food. 

It  will  be  noticed  that  all  the  examples  given  so  far  date  from 
comparatively  modern  times,  or  from  the  Quaternary  period,  and 
that  little  or  nothing  is  on  record  concerning  osteo-arthritis  in 
animals  which  lived  before  the  Quaternary  period.  M.  Fourtau, 
however,  has  drawn  my  attention  to  a  paper  by  L.  Mayet1  in  which 
this  author  mentions  and  gives  a  photograph  of  the  right  foot  of  a 
rhinoceros,  showing  ankylosis  of  the  metatarsal  bones  with  the  tarsus, 
with  surrounding  exostoses.     No  details  of  this  find  are  given. 

The  specimen  to  be  described  now  was  discovered  by  M.  Four- 
tau, of  the  Geological  Museum,  Cairo,  near  Hateyet  el  Mogharah, 
a  lake  of  the  Mariut  desert.  He  informed  me  that  the  specimen  was 
lying  in  a  Burdigalian  stratum  of  the  Lower  Miocene  period,  and 
that  it  is  not  less  than  900,000  years  old  and  very  probably  much 
older.  I  may  be  allowed  to  express  to  M.  Fourtau  my  best  thanks 
for  handing  this  unique  specimen  over  to  me. 

The  two  bones  are  completely  petrified  and  in  an  excellent  state 
of  preservation,  the  cancellous  structure  of  the  bone  being  perfect, 
and  though  the  specimen  had  been  broken  into  two  pieces  when 
lifted  out  of  its  bed,  its  fractured  surfaces  are  perfect  and  were  after- 
wards glued  together  with  excellent  results.  Unfortunately,  it  is 
not  possible  to  make  sure  to  which  of  the  two  kinds  of  petrified 
crocodiles  occurring  in  this  stratum  these  bones  belonged.2 

The  specimen  comprises  two  vertebrae  which  may  be  either  the 
last  lumbar  or  the  first  caudal  vertebrae.  Judging  from  their  size, 
it  may  be  assumed  that  the  length  of  the  animal  was  not  less  than 

'  L.  Mayet,  "fitude  des  mammifcires  mioc&nes  des  sables  de  l'Orleanais  et  des 
faluns  de  la  Touraine,"  Ann.  dc  I'Universite  de  Lyon,  nouvelle  s6rie,  No.  24  (1908). 

1  It  is  most  probable  that  these  vertebrae  belonged  to  the  species  of  "gavial"  now 
described  by  Mr.  Fourtau  under  the  name  of  Tomisloma  Dowsoni. 


190         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

5  m.,  including  a  tail  about  2.5m.  long.  The  body  of  the  anterior 
vertebrae  measures  0.5  m.,  and  that  of  the  second  0.54  m.  from 
above  downwards,  and  the  antero-posterior  diameter  of  the  anterior 
vertebrae  o  .054  m.  from  before  back,  and  o  .058  m.  from  side  to  side 
at  the  superior  border.  Owing  to  the  presence  of  new  bone,  the 
corresponding  measurements  of  the  posterior  vertebra  remain 
doubtful.  The  greater  part  of  the  two  spinous  processes  and  of 
the  transverse  processes,  with  the  exception  of  the  left  anterior 
process,  is  broken  off.  The  bases  are  smooth,  without  noticeable 
lesions. 

A  thick  band  of  osseous  tissue,  obviously  pathological,  firmly 
binds  together  the  vertebrae.  It  extends  to  the  left  side  at  A 
(Plate  XL  VIII,  4)  for  about  0.05m,  the  point  B  (Plate  XL  VIII,  4) 
being  0.05  m.  over  the  median  line.  From  the  point  A  (Plate 
XL VIII,  4)  the  osseous  band  running  upwards  forms  a  sinuous, 
raised  border  gradually  melting  into  normal  bone  at  the  base  of 
the  transverse  processes.  The  convex  superior  border  extends 
to  within  0.005  m.  (Plate  XL VII,  1  B  and  Plate  XLVIII,  4  C) 
of  the  anterior  border  of  the  vertebral  body.  From  the  point  B 
(Plate  XLVIII,  4)  the  new  bone  runs  almost  perpendicularly  down- 
wards to  C  (Plate  XL VII,  1)  for  almost  the  whole  length  of  the 
body  of  the  posterior  vertebra. 

On  the  right  side  (see  Plate  XL VII,  2),  the  pathological  osseous 
band  extends  to  the  base  of  the  transverse  process  of  the  posterior 
vertebra,  crosses  over  the  intervertebral  space  at  B,  spreading  then 
over  the  right  side  of  the  bodies  of  both  vertebrae.  At  B  (Plate 
XLVIII,  4)  the  new  bone  is  more  than  half  a  centimetre  thick. 

At  E  (Plate  XL VII,  1)  there  is  a  loss  of  substance  evidently  due 
to  a  post-mortem  traumatism,  whereas  the  hole  F  (Plate  XL VII, 
1,  2)  has  ah  the  characteristics  of  a  large  blood  vessel. 

A  distinct  pathological  osseous  arch  with  its  concavity  towards 
the  intervertebral  space  bridges  over  the  latter.  The  concave 
space  thus  formed  between  the  pathological  band  and  the  vertebrae 
was  full  of  fine  sand,  and,  when  this  had  been  washed  away,  the 
vertebrae  underneath  the  band  were  found  normal. 

Plate  XLVIII,  5,  represents  the  anterior  surface  of  the  anterior 
vertebra  and  it  shows  the  enormous  mass  of  new  bone  which  had 


LOWER  MIOCENE  SPECIMEN  191 

developed  along  the  lines  ab  and  ad.  This  figure  may  be  usefully 
compared  with  No.  6  (Plate  XL VIII),  the  photograph  of  the  inferior 
surface  of  the  body  of  a  dorsal  vertebra  of  an  ancient  Egyptian, 
with  the  lesions  of  spondylitis  deformans. 

In  both,  the  new  bone  is  sharply  separated  from  the  bodies  of  the 
vertebrae,  superadded  to  them,  so  to  speak,  and  is  thickest  on  one 
side.  The  surface  covered  by  the  cartilage  is  normal  and  other 
pathological  alterations  are  absent.  No.  5  (Plate  XLVIII)  shows 
that  part  of  the  bone  has  broken  after  death,  leaving  a  surface  which 
is  apparently  free  from  disease. 


The  first  idea  to  suggest  itself  was  that  the  lesion  might  have 
been  caused  by  a  traumatism,  a  blow,  for  instance,  and  that  the  new 
bone  was  simply  callus.  This  diagnosis  is  shown  to  be  fallacious  by 
the  fact  that  pathological  lesions  which  could  be  attributed  to  a 
traumatism,  severe  enough  to  produce  the  development  of  thick 
layers  of  bone,  e.g.,  sinus,  spiculae  of  new  bone,  loss  of  substance, 
etc.,  are  totally  absent.  On  the  other  hand,  the  changes  charac- 
teristic of  spondylitis  deformans,  as  observed  in  ancient  and  modern 
human  skeletons,  are  conspicuous. 

In  man,  the  first  and  most  characteristic  lesion  of  spondylitis 
deformans  is  the  growth  of  an  osteophyte  from  the  antero-lateral 
border  of  the  body  of  one  or  more  vertebrae.  As  a  rule,  three,  four, 
or  five,  or  more  vertebrae  are  thus  attacked,  and,  very  occasionally, 
the  disease  is  limited  to  one  or  two  vertebrae  (see  Plate  XL VII,  3). 
Fig.  3,  for  instance,  represents  two  Egyptian  human  vertebrae 
with  spondylitis  deformans,  dating  from  the  Roman  period. 
The  osteophytes  from  the  neighbouring  vertebrae  have  grown  until 
their  gradually  narrowing  extremities  have  met  at  a,  whereas  their 
bases  are  broader.  The  bridge  thus  formed  forms  an  arch,  the  con- 
cavity of  which  is  turned  towards  the  intervertebral  space.  The 
rather  soft  new  bone  is  not  eburnated,  and  this  is  the  case  even  when 
it  has  attained  a  considerable  size.  The  upper  and  lower  borders 
of  the  osteophyte,  not  more  than  two  or  three  millimetres  thick, 
are  usually  prolonged  in  this  case  for  a  few  millimetres  on  the 
body  of  the  vertebra,  and,  as  a  rule,  the  osteophytes  are  situated 


192         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

uni-  or  bilaterally,  hardly  ever  centrally,  and  the  posterior  border 
of  the  vertebrae  is  attacked  only  when  the  disease  has  made  some 
progress  already. 

In  a  later  stage  the  base  of  the  osteophytes  spread  out  on  the 
anterior  surface  of  the  bodies  until  those  from  the  superior  and 
inferior  borders  coalesce.  In  bilateral  disease,  the  osteophytes 
ultimately  extend  laterally,  cross  the  middle  line,  and  the  anterior 
and  lateral  surfaces  of  the  body  may  thus  be  covered  by  a  thick 
ring  of  bone. 

In  man,  osteophytes  springing  from  the  posterior  border  of  the 
body  are  never  more  than  o .  ooi  m.  or  o .  002  m.  thick,  and  therefore 
do  not  press  on  the  spinal  cord,  although  they  may  ultimately 
coalesce  with  the  anterior  and  lateral  osteophytes,  and  then  a  com- 
plete ring  of  osseous  tissue  surrounds  the  vertebrae  and  the  inter- 
vertebral spaces.  The  spinal  foramen  of  the  crocodile  also  is  not 
narrowed,  and  its  walls  show  no  pathological  changes. 

Intervertebral  discs  have  been  found  in  position  in  mummified 
bodies,  and  in  cases  of  spondylitis  the  discs,  though  shrunk,  appear 
normal.  The  intervertebral  spaces  of  skeletons  with  spondylitis 
are  neither  diminished  in  size  nor  altered  in  shape. 

This  description  applies  exactly  to  the  specimen  which  forms  the 
subject  of  this  paper,  and  the  two  photographs  (Nos.  3  and  6) 
demonstrating  the  changes  due  to  spondylitis  in  human  dorsal 
vertebrae  show  the  great  resemblance  between  the  lesions  of  this 
disease  in  man  and  those  seen  in  our  crocodile.  The  disease  in  the 
crocodile  evidently  began  on  one  side,  spread  to  the  middle  line, 
and  was  extending  on  the  other  side  at  the  time  of  death.  The 
bone  had  developed  in  the  antero-lateral  ligament,  or,  at  any  rate,  in 
its  close  proximity,  and  had  spread  along  the  anterior  surface  of  the 
body  of  the  vertebra  and  formed  a  typical  arch  over  the  space  for 
the  intervertebral  disc.  The  articulating  surfaces  showed  no 
pathological  alterations,  and  the  borders  of  the  spinal  foramen 
were  intact. 

In  the  crocodile  as  in  man,  therefore,  the  disease  is  more  marked 
on  one  side,  the  bone  forms  an  arch  over  the  space  for  the  interverte- 
bral disc,  and  the  upper  and  lower  surfaces  of  the  body  and  the 
spinal  foramen  are  untouched. 


PLATE  XLVII 


PLATE  XLVIT.I 


LOWER  MIOCENE  SPECIMEN  193 

I  conclude  that  the  pathological  lesions  which  crippled  the  verte- 
bral column  of  a  crocodile  living  not  less  than  900,000  years  ago  are 
exactly  similar  to  those  seen  in  modern  human  beings. 

DESCRIPTION  OF  PLATES  XLVII-XLVIII 

PLATE  XLVH 

Fig.  1. — Ventral  view  of  posterior  lumbar  or  anterior  caudal  vertebrae  of 
a  fossil  crocodile  (possibly  a  gavial  of  the  species  Tomistoma  dowsoni),  from 
the  Lower  Miocene  Period  of  Egypt,  showing  at  the  letters  A,  B,  C  the  limits 
of  the  growth  of  new  bone  due  to  spondylitis  deformans,  a  marks  the  inferior 
and  superior  points  where  the  lines  of  new  growth  converge.  E  marks  a  point 
at  which  there  has  been  some  loss  of  substance,  possibly  due  to  post-mortem 
traumatism.  F  indicates  a  rounded  opening,  possibly  occupied  by  a  blood- 
vessel. 

Fig.  2. — Right  lateral  view  of  same  vertebrae,  showing  at  B  the  new  bony 
growth,  and  at  F  the  vascular  opening. 

Fig.  3. — Lesions  of  spondylitis  deformans,  at  p,  in  the  thoracic  vertebrae 
of  a  man  of  the  Roman  period  in  Egypt.  Note  the  similarity  in  lateral  devel- 
opment of  the  lesion  in  man  and  crocodile. 

Figures  about  f  natural  size. 

plate  XLvni 

Fig.  4. — Left  lateral  view  of  vertebrae  of  fossil  crocodile  showing  extent 
of  osseous  lesions  at  A,  B,  C. 

Fig.  5. — View  of  anterior  end  of  anterior  vertebra  of  fossil  crocodile 
showing  development  and  overlipping  of  the  osseous  lesions  of  spondylitis 
deformans  along  the  lines  a-b  and  a-d. 

Fig.  6. — Posterior  aspect  of  dorsal  human  (Egyptian,  XXIId  Dynasty) 
vertebra  showing  lesion  of  spondylitis  deformans  at  the  lower,  left  angle. 

Figures  about  f  natural  size. 


SOME  RECENT  RESEARCHES  ON  PREHISTORIC 
TREPHINING 

{Journal  of  Pathology  and  Bacteriology,  Vol.  XXII  [1918]) 
PREFATORY  NOTE 

When  my  husband  left  last  winter  on  the  mission  to  Salonika  which  ended  in  his 
death  at  the  hands  of  the  enemy,  he  left  with  me  several  unfinished  works,  most  of 
which  he  intended  to  issue  under  the  title  of  "Studies  in  Palaeopathology."  Some 
of  the  series  had  been  published  prior  to  his  death  in  the  Journal  of  Pathology  and 
Bacteriology  (XV  [191 1],  r;  XVI  [iori-12],  439;  XVIII  [1913-14],  480),  and  elsewhere. 

According  to  my  husband's  instructions,  I  have  filled  up  certain  lacunae  in  the 
present  paper,  and  made  various  necessary  alterations.  He  did  not  profess  that  it 
contained  anything  new,  but  it  is  a  compilation  of  several  authors'  investigations 
into  this  subject,  to  be  used  as  a  reference. 

It  is  perhaps,  owing  to  the  untimely  death  of  the  author,  not  exhaustively  com- 
plete, but  matter  of  interest  may  still  be  found  in  this  paper  of  Sir  Armand  Ruffer's 
on  "Prehistoric  Trephining." 

Alice  Rotter 

The  facts  relating  to  this  science  are  scattered  through  anthro- 
pological, ethnological,  and  historical  memoirs,  and  especially 
through  papers  describing  excavations  of  ancient  sites.  The  pathol- 
ogist, therefore,  unless  in  touch  with  anthropology  and  allied 
sciences,  does  not  become  acquainted  with  the  latest  pathological 
finds,  and  yet  it  is  only  by  the  patient  accumulation  of  such  obser- 
vations that  the  science  of  the  history  of  disease  can  be  established 
on  a  firm  basis.  The  object  of  this  paper  is  to  put  on  record,  for  the 
benefit  of  pathologists,  observations  bearing  on  their  science  made 
during  the  last  few  years,  but  which  are  scattered  through  various 
publications.     I  have  added  a  few  facts  observed  by  myself. 

RECENT   OBSERVATIONS   ON   TREPANNING 

Trepanning  the  skull  was  an  operation  frequently  performed  in 
Neolithic  times,  especially  in  western  Europe,  and  quite  lately 
Baudouin1  has  again  found  in  western  France  a  number  of  trepanned 
skulls  dating  from  prehistoric  times,  which  are  interesting  from  the 

1  Marcel  Baudouin,  "Etude  d'un  crane  neolithique  a  double  trepanation," 
L'hommc  preliistoriquc,  V  (190S),  207. 


RESEARCHES  ON  PREHISTORIC  TREPHINING  195 

fact  that  some  had  been  trepanned  twice,  thrice,  and  even  four 
times.  Evidence  has  now  been  forthcoming  that  the  operation 
was  not  limited  to  western  Europe,  but  was  performed  also  in 
Bohemia  at  a  very  early  period. 

The  results  of  prehistoric  surgery  were  sometimes  very  good. 
The  cicatrisation  is  often  so  complete  that  no  doubt  can  exist 
regarding  the  patient's  survival  for  many  years.  In  some  skulls, 
however,  evidences  of  repair  are  completely,  or  almost  completely, 
absent,  either  because  the  patient  died  shortly  after  the  operation,  or, 
as  some  authors  maintain,  because  the  bone  was  removed  after  death. 

My  impression  is  that  the  majority  of  the  openings  which  have 
been  supposed  to  have  been  made  post  mortem  were  really  made 
during  life,  and  that  in  these  cases  death  supervened  very  shortly 
after  the  trepanning.  This  hypothesis  is  certainly  correct  in  cases 
when,  in  a  skull  with  two  or  more  trephining  holes,  one  or  more  are 
cicatrised,  whereas  one  opening  alone  shows  no  signs  of  repair. 
The  probability  then  is  that  the  subject  was  trephined  several  times 
for  chronic,  acutely  painful  disease,  e.g.,  tumor  cerebri,  and  that 
the  last  operation  was  fatal.  On  the  other  hand,  when  the  greater 
part  of  the  temporo-parietal  region  or  nearly  the  whole  of  one  side 
of  the  cranium  had  been  removed,  the  possibility  of  this  having 
been  done  on  the  living  is  very  slight.1 

It  has  been  suggested  that  post-mortem  operations  on  the  skull 
were  made  with  the  object  of  obtaining  pieces  of  cranial  bones  to 
be  used  as  amulets.  Indeed,  pieces  of  bone  detached  by  trephining 
("rondelles")  were  carefully  preserved,  for  not  only  are  some  of  them 
pierced  for  suspension,  but  their  smooth  borders  indicate  long 
friction  against  the  skin.  Powdered  cranial  bones  were  supposed 
to  possess  curative  properties  in  the  remote  past  and  up  to  the 
Middle  Ages,  and  rondelles  were  certainly  worn  as  ornaments  or  as 
amulets  as  late  as  Gallic  times. 

Discovery  of  trephined  prehistoric  skulls. — The  discovery  of  the 
first  trephined  prehistoric  human  skull  dates  from  1685;  it  was 
found  at  Cocheral.2     It  had  been  twice  "perforated,"  and  these 

'  I  have  seen  in  some  anthropological  museums  skulls  labelled  as  "trephined  post 
mortem"  in  which  I  could  not  find  any  real  evidence  of  ante-  or  post-mortem  operation. 
'  Cartailhac,  La  France  prchislorique,  Paris,  1889,  p.  281. 


196         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

perforations  are  now  considered  to  have  been  caused  by  a  surgical 
operation,  which  the  patient  survived  long  enough  for  his  wounds 
to  heal.  In  1816  another  trephined  prehistoric  skull  was  discovered 
at  Nogent-les-Vinages,  in  an  ossarium  containing  no  less  than  nine 
hundred  skeletons.  The  opening  in  this  cranium  measures  about 
3  by  2  inches,  and  at  the  time  the  skull  was  found  the  loss  of  sub- 
stance was  considered  as  due  to  a  wound  or  fracture,  which  had 
completely  healed.  Indeed,  Cuvier,  who  examined  this  skull, 
estimated  that  the  patient  survived  the  injury  for  a  dozen  years. 
It  is  now  recognised  that  the  aperture  was  due  to  a  trephining 
operation,  and  not  to  an  accident.  In  1872  Pruniere  drew  attention 
to  the  many  trephined  Neolithic  crania  discovered  in  ossaria,  grot- 
tos, or  dolmens  of  the  Lozere  region,  and  since  that  time  many 
trephined  skulls  have  been  brought  to  light  in  divers  places. 

French  discoveries  of  trephined  skulls. — The  largest  number  of 
trephined  prehistoric  heads  have  been  found  in  France,  e.g.,  at 
Enteroches  (Charente),  Moret  (Seine  et  Marne),  Tour-sur-Marne, 
Bougon  (Deux  Sevres),  Petit  Morin  (Marne),  Vienne,  Marennes 
(Puy  de  Dome),  Sorde  and  Fondonneau  (Basses-Pyrenees). 

A  short  account  may  be  given  of  a  few  particularly  interesting 
trephined  skulls  lately  found  in  that  country.  The  skull  of  a  man 
who  died  when  about  fifty  years  old,  found  at  Crecy-sur-Serre 
(Aisne),  was  pierced  by  two  trephining  holes.1  The  first  was  situ- 
ated on  the  antero-superior  angle  of  the  left  parietal  bone  near  the 
anterior  fontanelle,  and  the  second  was  above  the  right  temporal 
fossa,  almost  in  the  middle  of  the  inferior  border  of  the  right 
temporal  bone.  Absence  of  any  signs  of  repair  suggested  to  the 
discoverer  of  these  skulls  that  both  operations  had  been  performed 
after  death.  In  my  opinion  the  possibility  of  the  operation  having 
been  done  during  life,  and  having  been  followed  very  soon  by  death, 
cannot  be  denied. 

At  Montereau-sur-Seine,2  almost  sixty  miles  from  Paris,  two 
trephined  heads  were  discovered  in  a  prehistoric  burial.  No 
details  concerning  them  are  available  so  far. 

'Marcel  Baudouin,  "fitude  d'un  crane  neolithique  a.  double  trepanation," 
L'homme  prehistorique,  V  (1908),  207. 

3  Berthiaux, " Le  prehistorique  a.  Montereau,"  L'homme  prehistorique^l  (1908),  85. 


RESEARCHES  ON  PREHISTORIC  TREPHINING  197 

A  cranium1  of  an  adult  female  with  three  trepanations  is  prob- 
ably Neolithic,  but,  unluckily,  its  origin  is  somewhat  obscure.  The 
patient  survived  the  three  operations  long  enough  for  a  small 
exostosis  to  form  on  the  border  of  one  opening.  The  holes  are 
small  and  close  to  one  another,  the  first  being  situated  in  the  antero- 
superior  parietal  region;  a  second  in  the  same  region  on  the  right 
side;  and  the  third  not  far  behind  the  second.  The  diametres  of 
the  openings  (13  and  15  mm.)  somewhat  exceed  that  of  the  crown 
of  the  usual  modern  trephining  instrument,  and  the  sloping  borders 
of  these  orifices  indicate  that  the  operations  were  performed  by 
scraping  horizontally  with  a  sharp  flint,  and  not  by  cutting  with  a 
saw.  The  only  striae  present  are  on  the  posterior  margin  of  the 
third  hole,  and  indicate  that  an  instrument  had  been  used  vertically 
in  that  situation. 

Six  trephined  heads,2  unearthed  in  one  locality,  are  good 
examples  of  the  skill  of  Neolithic  surgeons.  A  piece  of  bone  90  by 
57  mm.  had  been  removed  from  the  right  parietal  bone  of  the  first 
cranium,  and  the  absence  of  any  signs  of  cicatrisation  proves  that 
death  supervened  soon  after  the  operation.  In  the  interior  of  the 
second  cranium,  which  presented  a  similar  lesion,  a  very  perfect 
rondelle  was  found,  which  measured  60  by  10  mm.  and  from  10  to 
7  . 5  mm.  in  thickness.  Some  striae  on  the  superior  surface  of  the 
rondelle  are  so  sharp  that  they  might  have  been  made  with  a 
graver's  tool.  The  context  and  illustrations,  however,  leave  one  in 
doubt  as  to  whether  the  rondelle  belonged  to  this  cranium  or  not. 
The  third  cranium  had  been  trephined  twice.  A  festooned  opening 
measuring  90  by  50  mm.  is  situated  over  the  right  temporal  and 
parietal  bones,  and  another,  almost  round,  measuring  36  by  30  mm., 
occupies  the  vertex  just  behind  the  left  parietal  bone.  Both  these 
apertures  show  no  signs  of  repair.  A  typical  trepanation,  measur- 
ing 20  mm.  in  diametre,  with  borders  showing  evidences  of  almost 
complete  repair,  occupies  the  upper  part  of  the  occipital  bone  of 
the  fourth  cranium.     The  fifth  cranium  shows  a  deep  depression, 

1  Marcel  Baudouin,  "  Etudes  d'un  crane  prehistorique  a  triple  trepanation  executee 
sur  le  vivant,"  Bulletin  de  la  Socieli  d 'Anthropologic,  1908,  p.  436. 

'  £mile  Schmit,  "Presentation  de  quelques  cranes  n6olithiques  trepanfis,"  ibid., 
■  .  206. 


198         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

measuring  go  by  55  mm.  on  the  occipital  protuberance,  in  the  centre 
of  which  there  is  an  artificial  aperture  probably  made  by  a  process 
of  scraping.  A  sixth  cranium  was  discovered  in  a  grotto  close  to 
that  in  which  the  five  others  had  been  buried.  On  the  left  parietal 
bone  of  this  skull  there  is  a  D-shaped  opening,  50  by  57  mm.,  due 
to  a  trepanation.  The  patient  survived  the  operation  for  a  long 
time,  as  the  borders  are  completely  healed. 

Trephined  crania  lately  discovered  in  other  parts  of  Europe. — 
During  the  last  forty  years,  trephined  crania  have  also  been  un- 
earthed in  Switzerland,  Bohemia,  Poland,  Denmark,  Thuringia, 
Sweden,  and  from  the  pile  dwellings  on  the  lake  of  Brienne,  at 
Chavannes,  Sutz,  and  Locres,  and  quite  lately  a  few  more  have 
been  discovered  in  countries  other  than  France.  A  skull  trepanned 
for  injury  has  been  found  in  a  Neolithic  grave  at  Hockergrab  in 
Bohemia.1  It  was  that  of  a  powerful  man  aged  between  fifty  and 
sixty  years,  and  a  hole,  measuring  40  by  60  mm.,  caused  by  a  blow 
or  a  fall,  was  situated  on  its  superior  part.  The  anterior  border  of 
this  hole  showed  the  action  of  pus,  and  the  discoverer  of  this  skull 
believes  that  an  operation  with  the  object  of  coping  with  suppura- 
tion had  been  performed  on  the  posterior  border,  and  that 
cicatrisation  had  progressed  far,  when  death  supervened. 

The  very  numerous  trephined  skulls  of  the  ossarium  of  Sedec 
(Bohemia),  though  probably  very  ancient,  are  not  accurately 
dated.2  A  skull,3  found  at  Mahren,  of  a  girl  approximately  ten 
years  old  at  the  time  of  death,  had  a  frontal  scar,  possibly  the  result 
of  a  surgical  trepanation.  This  cranium  dates  from  the  Bronze 
period,  and,  if  the  diagnosis  be  correct,  the  case  is  of  some  impor- 
tance, as  trephined  skulls  of  children  from  that  period  are  very  rare. 
Unfortunately,  details  regarding  this  and  the  preceding  cases  are 
wanting. 

Naked-eye  appearances  of  apertures  due  to  trephining. — The  holes 
due  to  the  operation  are  usually  described  as  being  fairly  regular, 
more  or  less  ellipsoid,  and  measure,  on  an  average,  about  4  cm. 

1  F.  V.  Griingel,  "Einige  prahistorische  Funde  aus  dem  Saager-Land,"  Pra- 
historischc  Zeitschrift,  CXI  (1911),  304. 

2  D.  Dudik,  Ethnologische  Zeitschrift,  1878,  p.  227. 

3  This  skull  was  discovered  by  Wankel,  and  described  by  Dudik,  loc.  cit. 


RESEARCHES  ON  PREHISTORIC  TREPHINING  199 

across.  The  borders  are  sharp,  oblique,  bevelled  from  without 
inwards,  and  very  often  the  singularly  compact  surfaces  produced 
by  the  growth  of  fresh  bone  prove  that  cicatrisation  took  place,  and 
that  the  patient  survived  the  operation  for  a  long  time. 

Reasons  for  trephining  in  prehistoric  times.. — Common  and  wide- 
spread as  trephining  was  in  Neolithic  times,  yet  very  little  is  known 
concerning  its  purpose  or  concerning  the  modus  operandi  of  the 
prehistoric  surgeon. 

According  to  the  theory  usually  accepted,  the  operation  was 
first  performed  from  time  immemorial  on  sheep  for  relief  of  "stag- 
gers," and,  later,  man  extended  the  application  of  this  veterinary 
method  to  his  species — firstly,  for  relief  of  severe  and  persistent 
headache  due  to  causes  unknown  to  him;  and,  secondly,  for  the 
removal  of  the  splinters  of  a  fractured  bone.  The  theory  of  the 
veterinary  origin  of  trephining  is  based  on  pure  hypothesis,  and 
I  know  no  facts  in  support  of  it. 

Broca  suggested  that  the  operation  was  performed  on  young 
epileptic  or  mad  subjects,  to  rid  them  of  the  "genius, "  the  "demon" 
causing  the  dreaded  symptoms.  Assuming  that  the  ideas  of 
Neolithic  men  resembled  those  of  some  modern,  partly  civilised 
peoples  who  honour  an  epileptic  or  lunatic  as  a  holy  man,  he  main- 
tained that  the  convulsive  accidents,  on  account  of  which  trephining 
was  performed,  endowed  the  patient  with  a  religious  character. 
The  patient  benefited  by  this  superstition,  for  both  he  and  his 
cranium  were  regarded  as  objects  of  reverence.  The  fact  that,  as 
we  have  seen,  rondelles  were  perforated  in  order  to  be  worn  lends 
some  support  to  this  theory.  The  full  discussion  of  Broca's  views, 
however,  would  entail  entering  into  questions  outside  the  scope  of 
this  present  paper,  and  must  therefore  be  left  for  the  present. 

lucas-championniere's  memoir 

A  paper  by  the  late  Lucas-Championniere1  contains  some  valu- 
able facts  regarding  the  methods  of  the  Neolithic  surgeon,  and  of 
his  contemporary  rival  in  Kabylia.  The  author  emphasised  the 
fact  that,  until  quite  lately,  trephining  had  fallen  completely  into 

1  Lucas-Championniere,  La  trepanation  prthisloriquc,  Paris,  1878;  Les  origincs 
dc  la  trepanation  compressive,  Paris,  191 2. 


200         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

disrepute  in  modern  Europe,  so  much  so  that,  in  1874,  Stromayer 
taught  that,  in  cases  of  comminuted  fracture  of  the  skull,  the  test 
treatment  was  to  wait  for  the  elimination  of  bony  splinters  by  sup- 
puration. Lucas-Championniere  maintains  that  in  Neolithic  times 
this  operation  was  based  partly  on  empiric  knowledge  and  partly  on 
a  regular  and  extended  series  of  observations ;  that  it  was  probably 
performed  for  many  reasons,  and  that  the  modern  operation  for 
fracture  of  the  skull  is  but  a  survival  of  an  old  custom. 

Geographical  distribution. — The  author  lays  stress  on  the  fact 
that  the  geographical  distribution  of  the  operation  is  peculiar,  for 


there  is  no  evidence  that  the  Hindoos  or  Chinese  ever  practised  it, 
and  no  specimens  of  trepanning  have  been  met  with  in  Egypt,1  nor 
among  the  Greeks  or  Romans.  Some  trepanned  crania,  however, 
have  been  discovered  in  Gaul,  belonging  to  an  epoch  corresponding 
to  that  of  Roman  civilisation. 

In  America,  previously  to  the  arrival  of  Europeans,  the  operation 
was  not  known  among  the  Redskins  of  the  North,  but  existed  in 
the  empires  of  Mexico,  Central  America,  and  was  especially  preva- 
lent in  Peru.     The  contemporary  hill  tribes  of   Daghestan,   the 

1  No  case  of  trepanning  in  ancient  Egypt  has  been  published,  but  lately  Dr. 
Arnoldo  Rietti  and  I  found  at  Alexandria  a  skull  dating  from  200  a.d.  which  appears 
to  have  been  trepanned.  We  hope  to  publish  the  case  in  full  before  long.  (Noie. — 
Dr.  Rietti  tells  me  that  owing  to  pressure  of  work  consequent  on  the  war,  he  has 
hitherto  been  unable  to  attend  to  this  matter,  but  hopes  to  write  the  paper  shortly. 
The  photograph  printed  herewith  is  of  the  skull  in  question. — Alice  Ruffer.) 


RESEARCHES  ON  PREHISTORIC  TREPHINING  201 

natives  of  Tahiti,  the  Polynesians  and  Loyalty  Islanders,  the  Kabyl 
tribes  (but  not  the  Arabs  or  Negroes  in  contact  with  them),  and 
Montenegrins  practise  this  operation,  and  thus  show  their  belief 
in  its  efficacy. 

Lucas-Championniere 's  experimental  investigations. — The  author 
then  discusses  the  results  obtained  by  several  modern  observers, 
who,  using  Neolithic  flint  instruments,  have  experimented  on  the 
dead  body,  in  order  to  discover,  if  possible,  the  modus  operandi  of 
the  prehistoric  surgeons. 

Three  methods  based  on  these  studies  have  been  described: 

1.  Muller's  method. — The  bone  is  slowly  scraped  away.  The 
sloping  border  so  produced  is  enormous  as  compared  with  the  aper- 
ture, and  therefore  unlike  that  of  the  majority  of  Neolithic  skulls. 

2.  Capitan's  method. — A  series  of  straight  or  curved  lines  having 
been  drawn  on  the  skull,  a  sharp  flat  instrument  is  first  passed  and 
repassed  along  these  lines  until  the  bone  between  them  becomes 
loose  and  can  be  removed.  The  objection  to  this  method  is  its 
tediousness  and  the  time  it  takes — more  than  one  hour  for  a  small 
opening.  Moreover,  the  borders  of  the  hole  thus  made  are  sloping, 
bevelled,  smaller  than  in  prehistoric  European  trephined  skulls, 
but  not  necessarily  smaller  than  the  openings  found  in  trephined 
Peruvian  crania. 

3.  Lucas-Championniere' s  method. — The  operation  is  performed 
in  several  stages.  (1)  The  bone  is  perforated  by  rotating  the  point  of 
sharp  flint.  (2)  A  circle  of  perforations  extending  to  the  inner  table 
is  made,  so  close  to  one  another  that  the  perforations  run  into  each 
other.  (3)  These  openings  are  further  connected  by  cuts  with  a 
sharp  instrument,  the  cutting  edge  of  a  flint  for  instance,  so  as  to 
obliterate  the  dentated  border  more  or  less  completely. 

The  edges  of  the  opening  in  trephined  prehistoric,  or  modern, 
savage  skulls  are  always  bevelled,  and  the  loss  of  substance  in  the 
external  table  therefore  exceeds  that  in  the  internal  table.  The 
orifice  is  triangular,  or  square,  or  irregular,  but  rarely  quite  round, 
and  this  irregularity  of  the  openings  may  have  been  the  reason 
why  many  trephined  prehistoric  skulls  passed  unnoticed  in  the  early 
days  of  anthropology.  In  some  Neolithic  skulls  a  smaller  opening 
is  present  near  the  larger  one,  and  the  object  of  this  is  unknown. 


202         STUDIES  IN  THE  PALAE0PATH0L0GY  OF  EGYPT 

In  Peruvian  skulls,  on  the  other  hand,  the  borders  of  the  opening 
are  often  festooned;  and  it  did  not  escape  Lucas-Championniere's 
notice  that  this  operation,  in  prehistoric  times,  was  not  necessarily 
fatal,  for  the  obliterated  osseous  canals  of  the  bevelled  edge  and  the 
smooth,  compact  bone  prove  that  the  patient  long  survived  the 
trepanation.  Repair,  however,  was  not  always  uniform.  Multiple 
trepanations,  though  not  rare  in  Neolithic  times,  are  seen  more 
frequently  in  Peruvian  skulls,  and  still  more  often  in  contemporary 
Kabyls. 

Lucas-Championniere's  investigations  in  Kabylia. — Lucas  Cham- 
pionniere  was  led  to  study  trephining  among  the  contemporary 
Kabyls,  and  he  describes  two  methods  used  in  Kabylia.  The  first 
consists  in  cutting  through  the  cranial  bones  by  making  straight 
strokes  with  a  short  rectilinear  saw.  In  the  second  method  the 
surgeon,  using  an  instrument  like  a  gimlet,  makes  a  complete  circle  of 
small  perforations,  then  connects  them  all  by  short  cuts  with  a  saw, 
and  finally  removes  the  piece  of  bone  thus  circumscribed.  Some- 
times both  methods  are  combined.  It  must  be  noted,  however, 
that  Lucas-Championniere  never  saw  the  operation  actually 
performed  by  Kabyls  (see  also  below). 

Lucas-Championniere' s  views  regarding  incomplete  operations. — 
The  author  insists  that  the  evidence  as  to  the  superstitious  use  of 
cranial  rondelles  as  amulets  is  not  altogether  satisfactory.  He 
explains  incomplete  trephinings  in  Neolithic  times  by  supposing 
that  the  operation  was  perhaps  divided  into  two  stages  (see  below) , 
and  that,  in  some  cases,  after  the  removal  of  the  external  table,  the 
second  part  of  the  operation  was  not  carried  out.  It  is  by  no  means 
clear,  however,  how  the  external  table  alone  could  be  removed  by 
Lucas-Championniere's  method.  Incomplete  trepanations  also  are 
not  rare  in  contemporary  Kabylia. 

Lucas-Championniere's  views  regarding  the  operation  on  chil- 
dren.— The  theory  that  trepanation  was  performed  on  children 
(Broca)  is  not  supported  by  evidence,  as  only  one  trephined  infantile 
skull  dating  from  Neolithic  times  has  been  found  in  France,  and 
none  have  been  discovered  in  Kabylia,  America  (before  the  con- 
quest), or  Montenegro.  On  the  other  hand,  several  trephined 
skulls  were  those  of  extremely  old  people. 


RESEARCHES  ON  PREHISTORIC  TREPHINING  203 

Lucas-Championniere' s  views  regarding  site,  etc.,  of  operation. — 
The  favourite  situations  for  trephining  in  prehistoric  times  were 
the  posterior  part  of  the  frontal,  and  especially  the  parietal  bones 
as  far  as  the  occipital  bone,  on  which  the  operator  never  trespassed 
much.  The  sagittal  suture  was  avoided  so  carefully  that  it  has 
been  suggested  that  at  a  time  when  man  was  unacquainted  with  the 
use  of  iron,  he  knew  enough  anatomy  to  avoid  the  longitudinal  sinus, 
and  some  authors  have  gone  so  far  as  to  believe  that  Neolithic  man 
had  some  knowledge  of  the  motor  centres.  The  Kabyls  choose  the 
same  regions  for  the  operation,  and  they  also  have  learnt  how  to 
keep  clear  of  the  dangerous  region,  the  longitudinal  sinus. 

As  a  rule,  no  traces  of  an  accident  are  noticeable  in  trephined 
Neolithic  skulls,  and  the  operation  therefore  either  was  not  done 
for  traumatism,  or,  if  performed  for  that  reason,  the  splinters  were 
carefully  removed  with  the  neighbouring  bone. 

No  information  exists  regarding  the  dressing,  if  any,  used  by 
prehistoric  peoples.  Kabyls  apply  to  the  wounds:  (1)  tar;  (2) 
honey  which  has  been  cooked;  (3)  butter  melted  and  cooked 
(Lucas-Championniere) . 

Discussion  of  modus  operandi  of  prehistoric  people. — Discussing 
the  various  methods  supposed  to  have  been  used  by  prehistoric 
peoples,  Lucas-Championniere  rejects  the  theory  that  the  aperture 
was  made  by  simple  scraping,  for  the  following  reasons:  (1)  such 
an  operation  would  take  a  very  long  time;  (2)  it  would  be  attended 
by  much  haemorrhage;  (3)  a  rondelle  could  not  be  removed 
in  that  way  (this  last  argument  appears  to  me  conclusive  as  far 
as  a  large  number  of  cases  is  concerned);  (4)  this  technique 
would  be  useless  when  the  bone  to  be  trephined  was  really  hard; 
(5)  the  cranial  openings  would  be  unlike  those  actually  found;  (6) 
the  bevelled  border  would  be  much  wider  than  is  usually  the  case. 

Lucas-Championniere  admits  that  some  operation  resembling 
Capitan's  process  may  have  been  used  where  the  cranial  openings 
are  square,  but  maintains  that  his  own  method  was  the  one  gener- 
ally used.  The  fact  that  the  opening  is  not  festooned  (as  it  should 
be  if  Lucas-Championniere's  method  had  been  used),  this  author 
endeavours  to  explain  by  the  supposition  that,  after  the  operation, 
Hh    urgeon  bad  taken  the  trouble  to  "correct"  these  irregularities, 


204         STUDIES  IN  THE  PALAE0PATH0L0GY  OF  EGYPT 

though  in  my  opinion  such  "corrections"  would  have  served  no 
useful  purpose,  and  would  have  caused  a  good  deal  of  unnecessary 
pain. 

Lucas-Championniere's  views  regarding  the  reasons  for  the  opera- 
tion.— The  author  points  out  that  the  evidence  of  the  superstitious 
use  of  cranial  rondelles  as  amulets  is  not  altogether  satisfactory. 
He  believes  that  the  only  object  in  view  was  the  cure  of  disease 
supposed  to  have  its  seat  in  the  head,  and  especially  of  the  diseases 
usually  attended  by  severe  headache.  The  relief  afforded  by  the 
removal  of  splinters  from  a  fractured  skull  may  possibly  have  sug- 
gested an  operation  in  cases  where  the  pain  was  due  to  hidden 
disease,  and  on  this  theory  surgeons  may  be  said  to  have  practised 
"cerebral  decompression"  as  early  as  Neolithic  times. 

The  Kabyls  trephine  sometimes  for  accidents,  and  more  often 
for  persistent  headache.  Such  is  their  confidence  in  the  beneficent 
results  of  this  operation  that,  should  it  be  unsuccessful  once,  they 
willingly  undergo  another.  Sometimes  the  external  table  alone  is 
removed.  We  may  point  out,  however,  at  once  that  later  investiga- 
tions do  not  confirm  this  author's  accounts  of  Kabyl  methods.  The 
art  of  trephining  is  a  family  craft,  and  the  operators  believe  in  it 
most  thoroughly;  for  the  hakeem  (medical  practitioner),  Lucas- 
Championniere's  informant,  had  been  trephined  three  times,  and 
his  father  twelve  times.  Three  of  his  brothers  were  operators  also. 
The  author  mentions  that  the  Cornish  miners,  at  the  beginning  of 
last  century,  thought  so  little  of  the  operation  that  they  insisted  on 
being  trephined  after  accidents  to  the  skull,  and  proceeded  home 
immediately  after  the  operation.  One  Cornish  surgeon  had  oper- 
ated sixty  times,  and  another  had  assisted  during  his  apprentice- 
ship at  forty  trephinings.  He  supposes  that  in  Cornwall  the  custom 
dated  from  prehistoric  times. 

Objections  to  Lucas-Championniere's  suggested  method  of  trephin- 
ing.— There  are  several  objections  to  Lucas-Championniere's  con- 
clusion that  a  similar  method  was  used  by  prehistoric  surgeons. 
In  the  first  place,  the  rondelles  which  I  have  seen  in  French  and 
other  collections  are  never  notched,  as  they  would  be  had  this 
method  been  used.  Secondly,  I  have  not  seen  dentated  borders  of  a 
trephine  wound  except  in  one  Peruvian  skull.    Lucas-Championniere 


RESEARCHES  ON  PREHISTORIC  TREPHINING  205 

gives  a  photograph  of  this  skull  in  his  memoir  and  admits  that 
this  patient  must  have  died  very  soon  after  the  operation,  as  all 
signs  of  repair  are  wanting.  For  my  part,  I  consider  it  far  more 
probable  that  this  opening  was  made  after  death  by  the  embalmer 
in  order  to  remove  the  brain.  The  Egyptian  embalmers,  it  is  well 
known,  extracted  or  washed  out  this  organ  through  the  nose.  It 
is  true  that  Lucas-Championniere  succeeded  in  trephining  a  skull 
by'this  methoci  so  skilfully  that  the  borders  of  the  opening  were  not 
festooned.  This  fact  does  not  meet  the  objection  just  raised,  for 
what  may  be  comparatively  easy  to  a  skilful  surgeon  of  the  nine- 
teenth century  may  have  been  impossible  to  a  Neolithic  surgeon. 
The  borders  of  an  opening  thus  made  must  have  been  festooned 
unless  our  prehistoric  colleague  took  great  pains  to  round  off  the 
aperture  after  the  operation,  and,  personally,  I  can  think  of  no  reason 
for  his  doing  so.  Thirdly,  in  Lucas-Championniere 's  diagram  of 
the  operation,  no  less  than  thirteen  perforations  are  indicated. 
Granting  that  no  such  large  number  would  be  required,  yet  an 
operation  requiring  several  perforations  of  both  tables  of  the  skull 
with  a  sharp  instrument  must  have  been  a  most  dangerous  one,  each 
drilling  increasing  the  chances  of  wounding  the  dura  mater.  Even 
the  Kabyls  carefully  avoid  wounding  this  membrane.  Fourthly,  it 
is  extremely  difficult,  if  not  impossible,  to  perform  by  this  method 
an  operation  limited  to  removal  of  the  external  table  of  the  skull,  and 
we  have  seen  that  such  incomplete  operations  were  by  no  means 
rare. 

Proof  that  Lucas-Championniere 's  method  was  not  always  used. — 
There  are  two  facts  which  show  that  two  methods  entirely  different 
from  Lucas-Championniere's  were  occasionally  used. 

Firstly,  before  the  European  invasion,  this  operation  was  some- 
times performed  in  Peru  by  marking  off  a  small  area  of  the  skull 
with  straight  lines,  and  then  incising  with  a  powerful  instrument 
along  these  lines.  This  method  is  clearly  shown  in  a  skull  in  the 
Trocadere  Museum  (Paris)  which  exhibits  four  deep  cuts,  and  from 
between  them  a  piece  of  bone,  almost  round,  has  been  removed. 
The  incisions  were  made  with  a  very  sharp  and  powerful  cutting 
instrument,  and  not  with  a  scraping  instrument,  and  the  operation 
had  evidently  been  bunglerl  \>y  the  surgeon,  whose  incisions  were 


206         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

too  long  and  too  close  together.  I  have  seen  no  incision  resembling 
it  in  European  skulls,  and  the  scars  suggest  a  technique  and  instru- 
ments very  different  from  those  used  in  Europe. 

Secondly,  a  prehistoric  skull  in  the  Lisbon  Museum  shows 
clearly  that  the  area  of  bone  to  be  removed  was  first  circumscribed 
with  a  powerful  instrument,  e.g.,  a  strong  flint  knife.  On  the  top 
of  this  skull,  a  deep,  ellipse-shaped  furrow  encloses  a  piece  of  the 
bone  measuring  about  50  by  40  mm.,  but  the  furrow  does  not 
penetrate  the  whole  thickness  of  the  bone,  and  lines  and  scratches 
round  this  groove  demonstrate  that  the  instrument  often  slipped 
during  this  operation.  For  some  unknown  reason,  the  trephining 
was  never  completed,  although  the  patient  apparently  survived 
for  some  time.  In  this  case  Lucas-Championniere's  method  was 
certainly  not  used. 

Hilton  Simpson's  investigations  in  kabylia 

Recent  observations  on  the  modern  modus  operandi  in  Kabylia 
and  New  Caledonia  throw  some  light  on  the  question  of  the  tech- 
nique used  in  ancient  times.  The  facts  relating  to  Kabylia  were 
observed  by  Mr.  Hilton  Simpson1  during  a  stay  of  more  than  two 
months  at  El  Kantara,  "the  mouth  of  the  Sahara,"  and  during  a 
journey  of  one  month's  duration,  in  the  spring  of  1913,  among  the 
Shewia  Berbers  of  the  Wady  Abdi,  and  the  Valley  of  Bouzina,  in 
the  western  parts  of  the  Atlas  Mountains. 

The  author  gives  a  description  and  illustrations  of  a  complete 
set  of  Kabyl  trephining  instruments,  nine  in  number,  and  all  bear- 
ing unmistakable  signs  of  having  been  used.  Marks  of  burning 
upon  their  wooden  handles  which  from  their  appearance  could 
scarcely  have  been  made  when  the  blades  were  hafted,  showed 
that  apparently  these  instruments  had  been  passed  through  the  fire. 

These  instruments  are:  (1)  Scalper  (Arabic  name,  matabaa):  A  cylinder  of 
iron  about  i|  inch  in  depth  and  if  inch  in  diameter,  made  of  a  strip  of  iron 
with  one  sharp  edge,  bent  round  until  the  ends  touch  without  being  joined. 
Where  the  ends  meet,  one  is  joined  by  fusion  on  its  blunt  edge  to  a  round  bar  of 
iron  about  13  inches  long,  so  that  the  cylinder  is  at  right  angles  to  the  bar.    The 

1  Hilton  Simpson,  Journal  of  Anthropology,  1914. 


RESEARCHES  ON  PREHISTORIC  TREPHINING  207 

other  end  of  the  bar  passes  through  a  round  wooden  handle  4  inches  in  length, 
and  is  bent  round  at  right  angles  to  prevent  this  handle  from  slipping  off.  (2) 
Retractor  (Arabic  name,  shefira) :  An  iron  blade  25  inches  in  length  was  fitted 
into  a  round  wooden  handle  35  inches  in  length.  The  blade  where  it  joins 
the  handle  is  rectangular  in  section  and  about  \  inch  wide,  but  it  gradually 
becomes  flatter  and  wider  until  at  the  distal  end  it  is  about  |  inch  wide,  the 
end  being  slightly  rounded  at  the  corners  and  presenting  a  fairly  sharp  edge. 
This  end  is  .bent  over  at  right  angles  to  the  rest  of  the  blade  to  form  a  hook. 
The  whole  blade  slopes  slightly  backwards  for  the  handle.  (3)  Retractor 
(Arabic  name,  shefira) :  An  iron  blade  projecting  about  if  inch  of  its  length, 
the  blade  is  rectangular  in  section  and  about  5  inch  wide,  but  the  distal  end 
is  flat,  widening  to  a  width  of  f  inch,  is  bent  round  at  right  angles,  forming 
a  hook,  the  fairly  sharp  edges  of  which  are  slightly  rounded  at  the  corners. 

(4)  Hook  or  Retractor  (Arabic  name,  mongash) :  An  iron  blade  about  ilf  inch 
long,  inserted  in  a  lathe-turned  wooden  handle,  presumably  of  European 
origin.  Where  it  joins  the  handle  the  blade  is  rectangular  in  section  and 
about  I  inch  wide,  but  it  narrows  to  the  distal  end,  which  is  little  more  than 
i\  inch  in  width.     The  distal  end  is  bent  sharply  round  to  form  a  small  hook. 

(5)  Drill,  also  used  as  an  elevator  (Arabic  name,  herwerl) :  An  iron  blade  about 
2§  inches  long  projecting  from  a  round  wooden  handle  35  inches  in  length. 
Where  it  joins  the  handle,  the  blade  is  £  inch  wide,  and  it  gradually  increases 
to  a  width  of  f  inch  near  the  distal  end;  it  narrows  abruptly,  leaving  a  "shoul- 
der" on  each  side,  at  the  distal  end,  so  that  the  last  A  inch  of  the  blade  is  only 
J  inch  wide.  This  end  is  rounded  and  has  a  cutting  edge.  The  "  shoulders  " 
on  the  blade  would  serve  to  prevent  too  large  a  hole  being  made  through  the 
skull  when  the  instrument  is  used  as  a  drill.  (6)  Saw  (Arabic  name,  monshar, 
or  manshar) :  Consists  of  an  iron  blade  projecting  si  inches  in  length,  fixed  into 
a  round  wooden  handle  25  inches  long.  The  blade  is  rectangular  in  section 
where  it  joins  the  handle,  and  is  about  5  inch  wide.  It  curves  downwards 
almost  at  right  angles,  2  inches  from  the  handle,  and  then  curves  outwards 
again  at  the  distal  end,  where  the  blade  is  flat  with  a  serrated  lower  edge  con- 
taining eleven  teeth.  The  serrated  edge  forms  a  segment  of  a  circle,  the  teeth 
being  upon  the  convex.  (7)  A  second  saw  (very  similar  to  No.  6):  An  iron 
blade  4!  inches  long  and  in  a  wooden  handle  about  2f  inches  long.  The  curves 
in  this  saw  are  not  so  sharp  as  in  No.  6,  there  are  thirteen  teeth  on  its  convex 
edge.  Neither  of  these  two  saws  is  sharp.  (8)  A  third  saw:  An  iron  blade 
2.1  inches  in  length  with  a  round  wooden  handle  3J  inches  long.  The  blade  for 
1 11..  inch  from  the  handle  is  rectangular  in  section,  and  about  5  inch  wide;  the 
last  i  of  the  blade  is  a  flat  rectangular  surface  with  three  serrated  edges.  The 
teeth  are  fine  and  sharp.  (9)  Elevator  (Arabic  name,  mhez) :  A  flat  iron  blade 
about  3  ,J0  inches  wide,  protruding  about  rf  inch  from  a  round  wooden  handle 
i\  inches  long.  The  distal  end  curves  very  slightly  indeed,  and  is  fairly  sharp. 
The  corners  are  not  rounded,  but  one  of  them  has  been  broken  off. 


2o8         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  method  of  trephining  used  by  the  Kabyls  is  as  follows : 

The  first  stage  of  the  operation  consists  in  removing  a  portion  of  the  scalp 
in  order  to  expose  the  place  to  be  trephined.  This  is  effected  by  making  the 
"funnel-like"  instrument  (malabaa)  white  hot  and  placing  it  firmly,  like  a 
branding  iron,  on  the  head;  a  flicking  movement  of  the  instrument  then 
removes  the  piece  of  scalp  thus  burnt  round.  The  great  heat,  as  well  as 
sterilising  the  matabaa,  also  prevents  excessive  bleeding  from  the  scalp.  The 
retractors  (shefira)  are  then  used  to  draw  away  the  scalp  around  the  place  to 
be  trepanned,  in  order  to  give  room  for  the  use  of  the  saw.  Presumably  the 
hook  (mon gash)  is  also  used  for  the  same  purpose.  A  hole  is  then  drilled  in 
the  skull  by  spinning  the  drill  (herwerl)  between  the  palms  of  the  hands.  This 
is  to  let  out  any  pus  and  blood  that  may  be  under  the  skull,  but  the  hole  thus 
made  would  also  be  useful  as  a  starting-place  for  the  saw.  The  saw  is  then 
applied  to  the  "good"  bone  just  clear  of  the  injured  part.  Only  a  very  small 
amount  is  sawn  through,  after  which  the  elevator  on  the  hook  is  inserted  in 
the  incision,  and,  if  possible,  the  "bad"  bone  slightly  raised  to  let  out  pus 
and  blood.  Great  care  is  taken  that  the  dura  mater  is  not  pierced,  for  the 
operator  thinks  that  the  patient  must  die  if  this  is  done. 

Only  the  small  incision,  with  the  saw  described  above,  is  made  on  the  first 
day,  but  on  the  next  and  each  succeeding  day  the  process  is  repeated  until  the 
whole  of  the  "bad"  bone  has  been  removed.  So  little  is  sawn  through  each 
day  that  it  takes  from  fifteen  to  twenty  days  to  remove  a  portion  of  skull  as 
large  as  a  penny  piece.  The  part  sawn  away  is  lifted  from  the  head  by  the 
elevator  or  the  hook. 

When  the  "bad"  bone  has  at  last  been  removed,  no  artificial  bone  or  plate 
is  placed  over  the  cavity,  and  the  skin  is  induced  to  grow  again  over  the  wound 
by  the  daily  application  of  fresh  dressings  of  a  mixture  of  honey  and  butter, 
and  the  stem  and  leaves  of  an  herb,  powdered  as  fine  as  snuff.  This  herb  grows 
locally  upon  the  hills,  and  belongs  to  a  species  of  labiatae.  The  daily  dressing 
is  continued  sometimes  for  as  long  as  one  month,  at  the  end  of  which  time  the 
patient  is  cured.  No  form  of  anaesthetic  is  used.  There  is  no  evidence  of 
any  attempt  to  sterilise  the  saw,  the  retractors,  or  the  elevator  (unless  we 
accept  the  burns  on  the  handles  of  the  instruments  as  an  indication  that  they 
have  been  purposely  sterilised  by  heat),  and  the  rags  used  as  bandages  are  of 
the  dirtiest  description.  The  surgeon  does  not  wash  his  hands,  as  a  rule,  before 
or  after  dressing  a  wound. 

A  native  surgeon  stated  that  he  trephined  as  many  as  five  or 
more  heads  annually,  the  reason  for  the  operation  being  usually 
heads  "broken"  by  blows  from  sticks  or  stones.  Operations  for 
the  removal  of  damaged  bone  from  the  arms  and  legs  were  per- 
formed in  the  same  manner  and  with  the  same  instruments. 


RESEARCHES  ON  PREHISTORIC  TREPHINING  209 

The  Kabyl  operation,  therefore,  according  to  this  author,  is 
performed  to  remove  splinters  of  bones  after  accidents.  It  is 
difficult  to  reconcile  this  statement  with  Lucas-Championniere's 
assertions,  firstly,  that  some  patients  have  been  trephined  twice; 
and  secondly,  that  the  Kabyls  trephine  chiefly  for  headaches. 
Neither  of  these  authors  mentions  whether  Kabyls  attach  any 
religious  importance  to  the  operation,  nor  whether  they  regard  the 
removed  bone  as  a  charm  or  an  amulet. 

TREPHINING   IN   NEW   CALEDONIA 

G.  Nicolas  gives  an  account  of  a  totally  different  method  in  use 
among  the  contemporary  New  Caledonians.  The  operator  makes 
a  crucial  incision  on  the  scalp  with  the  sharp  edge  of  a  large  broken 
bottle  or  a  razor,  and,  having  turned  the  flaps  aside  with  his  fingers, 
files  away  the  bone  with  a  cutting  and  sharpened  shell.  The 
operation  is  often  badly  carried  out,  for  it  may  be  incomplete,  or, 
contrariwise,  the  membranes  of  the  brain  may  be  injured.  The 
wound  is  then  closed  by  placing  a  shell  over  it,  and  Nicolas  himself 
has  felt  such  a  shell  in  situ.  The  cutaneous  flaps  being  turned  back 
a  dressing  of  certain  chewed  herbs  is  applied.  The  chief  indication 
for  the  trephining  is  persistent  headache,  and  a  man  who  had  suf- 
fered excruciating  pains  after  a  fall  on  the  head  reported  that  he 
had  been  completely  cured  by  the  operation. 

Trephining  is  carried  out  fairly  often.  One  skull  completely 
and  another  incompletely  trephined  were  found  in  a  cave  containing 
some  hundreds  of  skeletons. 

CONCLUSIONS 

The  conclusions  to  be  drawn  from  the  new  facts  related  in  this 
review  are  as  follows: 

1.  The  operative  methods  of  Neolithic  people  are  very  imper- 
fectly known. 

2.  Further  investigations  with  regard  to  Kabyl  methods  are 
necessary,  as  the  Kabyl  methods  described  by  the  French  author 
are  not  identical  with  those  mentioned  by  the  British  traveller. 
This  may  be  due  to  the  fact  that  the  observations  of  the  two  authors 
were  made  in  different  parts  of  Kabylia.  Both  may  therefore  be 
right. 


210         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Contemporary  Kabyl  methods  differ  greatly  from  those  used  in 
contemporary  New  Caledonia.  Neolithic  people  therefore  may 
have  employed  not  one  but  several  methods,  either  at  the  same 
time  or  consecutively,  or  in  different  regions. 

3.  Contemporary  Kabyls  trephine  for  accidents,  and,  according 
to  Lucas-Championniere,  for  persistent  headache  also.  Contempo- 
rary New  Caledonians  trephine  chiefly  for  the  relief  of  headache. 
Similarly,  Neolithic  people  may  have  trephined  for  injuries,  but  as 
most  of  the  trephined  skulls  show  no  signs  of  accidents,  headache 
was  very  probably  the  chief  indication  for  this  operation.  No  fresh 
evidence  has  been  obtained  to  show  that  a  religious  signification 
was  attached  to  trephining. 

4.  Lastly,  I  would  suggest  that  the  trephining  hole  is  situated 
in  the  upper  and  posterior  part  of  the  parietal  bone,  probably 
because  this  region  was  most  easily  accessible  to  the  operator  in  a 
period  when  beds  and  chairs  were  not  used.  The  contemporary 
barber-surgeon  in  the  East  when  operating  invariably  squats  in 
front  or  behind  the  patient,  and  in  thus  doing  copies  his  colleagues 
of  ancient  times.  A  picture  on  a  tomb  at  Beni-Hassan,  dating 
from  over  three  thousand  years,  shows  the  barber-surgeon  squatting 
before  a  man  on  whose  head  he  is  performing  some  kind  of  opera- 
tion. The  walls  of  a  tomb  of  Sakkarah  are  decorated  with  bas- 
reliefs  representing  operations,  and  among  them  some  operation  on 
the  penis  of  a  youth.1  In  this  bas-relief  also  the  surgeon  squats 
down  before  the  sufferer,  whose  hands  are  held  before  his  face  by  a 
man  standing  behind,  who  thus  not  only  prevents  untoward  move- 
ments, but  also  hides  the  operation  from  his  prisoner.  In  another 
bas-relief,  the  patient,  still  standing  up,  rests  his  right  hand  on 
the  squatting  operator's  head.  Other  bas-reliefs  of  the  same 
tombs  are  not  sufficiently  well  preserved  to  allow  a  diagnosis  of 
the  operation  to  be  made,  but  in  all  the  surgeon  either  squats  on 
the  ground  or  sits  on  a  low  (stone  ?)  stool  either  before  or  behind 
his  patient.  The  Neolithic  surgeon  probably  took  up  the  same 
position,  and  the  patient's  head  was  either  held  by  an  assistant 
or  by  the  operator  himself,  and,  like  his  contemporary  Egyptian 

1  The  picture  is  supposed  to  represent  a  circumcision,  but  I  can  see  no  evidence 
of  that. 


RESEARCHES  ON  PREHISTORIC  TREPHINING  211 

colleagues  operating  on  the  scalp,  he  encircled  and  held  the  head 
firmly  with  his  left  arm,  and  operated  with  his  right  hand. 

Excellent  hold  is  obtained  on  a  person's  head  either  in  this  man- 
ner or  by  fixing  the  head  between  the  knees.  It  is  best  for  the 
operator  to  sit  a  little  higher  than  the  patient,  e.g.,  on  a  stone,  and 
for  the  patient  to  squat  between  the  operator's  legs.  Whether  the 
surgeon  sits  before  or  behind  the  patient  makes  no  difference,  for, 
in  either  case,  the  upper  parietal  region  is  the  region  most  easily 
reached. 

In  order  to  study  the  question  experimentally,  I  have  asked 
several  people,  ignorant  of  surgery  and  not  acquainted  with  my 
object,  to  sit  in  the  position  thus  described.  I  then  asked  one  of 
them  (the  operator)  to  catch  hold  of  the  other  person's  (the  pa- 
tient's) head  and  pretend  to  drill  a  hole  in  it.  The  point  invariably 
chosen  for  this  drilling  was  the  parietal  region,  and,  strangely 
enough,  not  the  vertex  but  the  side  of  the  parietal  bone,  and  usually 
the  left  side.  These  points  correspond  almost  exactly  with  those 
which  were  most  often  trephined  in  prehistoric  skulls,  and  I  suggest 
therefore  that  the  reason  why  prehistoric  surgeons  trephined  most 
often  the  parietal  region  of  the  skull  was  because  that  region  was 
by  far  the  easiest  to  operate  on,  when  both  patient  and  operator 
squat  on  the  ground. 


ARTHRITIS  DEFORMANS  AND   SPONDYLITIS  IN 
ANCIENT  EGYPT 

{Journal  of  Pathology  and  Bacteriology ,  Vol.  XXII  [191 8] 

PREFATORY  NOTE 

When  starting  in  December,  1916,  on  a  mission  which  was  evidently  attended  by 
dangers  and  which  finally  proved  fatal  to  my  husband,  he  left  with  me  instructions 
as  to  various  unfinished  papers  at  which  he  and  I  had  worked  together. 

It  was  his  written  wish  that  the  present  part  of  his  "Studies  in  Palaeopathology  " 
should  be  submitted  to  his  friend  and  former  assistant,  Captain  J.  G.  Willmore, 
R.A.M.C.,  who  has  kindly  devoted  his  short  leave  during  the  summer  of  1017  to 
assisting  me  to  prepare  this  paper  on  "Arthritis  Deformans."  We  have  decided  to 
eliminate  certain  short  passages  wherever  we  had  doubts  as  to  Sir  Armand's  inten- 
tion rather  than  give  a  possibly  erroneous  impression.  We  have  not,  however, 
attempted  to  write  a  summary  or  conclusions,  such  as  my  husband  would  certainly 
have  given,  since  the  paper  speaks  for  itself,  and  we  preferred  not  to  add  any  matter 
which  he  had  not  time  to  prepare. 

Captain  Willmore  undertook  the  arduous  task  of  supplying  references,  which 
my  husband  left  to  be  filled  in,  searching  for  suitable  illustrations,  etc. 

My  very  sincere  thanks  are  due  to  Captain  Willmore  for  this  labour  of  love, 
undertaken  for  his  former  chief  in  the  Quarantine  Service  of  Egypt.  Without  his 
valuable  help,  I  might  never  have  been  able  to  give  to  the  world  this  part  of  Sir 
Armand  Ruffer's  "Studies  in  Palaeopathology." 

Alice  Ruffer 

December,  191 7 

INTRODUCTION   TO    THE   STUDY   OF   ARTHRITIS   IN 
ANCIENT  EGYPT 

Arthritis  deformans  is  a  chronic,  painful,  debilitating  disease, 
which  in  many  cases  goes  steadily  from  bad  to  worse.  The  lesions 
in  the  neighbourhood  of  the  articular  surfaces  cause  pain  in  the 
joints  and  tendons,  together  with  muscular  spasms  whenever  the 
articulations  are  moved. 

The  vertebral  lesions  of  spondylitis  deformans  gradually  dis- 
qualify a  patient  from  earning  his  living  by  agricultural  pursuits, 
hunting,  netting  fish,  or  indeed  by  any  manual  labour,  or  any  pur- 
suit requiring  even  moderate  physical  exertion. 

The  pain  in  many  of  the  ancient  Egyptians  whose  lesions  have 
been  described  must  have  been  very  severe.  As  the  lumbar  spine 
was  the  part  most  frequently  involved,  it  follows  that  these  people 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  213 

suffered  severely  from  lumbago,  sciatica,  pains  and  cramps  in  the 
lower  limbs.  The  skeletons  do  not  show  any  lesions  proving  that 
the  spinal  nerves  were  pressed  upon,  but  the  osseous  lesions  are 
only  a  fraction  of  the  pathological  alterations  present  during  life, 
and  the  vertebral  lesions  were  undoubtedly  surrounded  by  a  wide 
area  of  inflammatory  exudate  which  pressed  heavily  on  the  spinal 
nerves  (Plate  XLIX,  Fig.  1)  and  possibly  caused  intense  pain  during 
life.  The  sleepless  nights  due  to  the  pain  coming  on  suddenly  dur- 
ing sleep,  the  alterations  in  the  general  nutrition  due  to  the  intense 
suffering,  must  have  sufficed  to  alter  profoundly  the  physical  and 
mental  well-being  of  the  ancient  Egyptians. 

The  limitation  of  movement  caused  by  the  pressure  of  spondy- 
litis deformans  was  very  great  in  some  cases,  and  the  aspect  and 
carriage  of  the  patient  must  have  varied  according  to  whether  the 
intervertebral  cartilages  had  been  absorbed  or  not. 

When  the  absorption  had  taken  place  in  the  lumbar  or  cervical 
regions,  the  favourite  places  for  such  alterations,  the  collapse  of 
several  intervertebral  spaces  undoubtedly  caused  marked  deformity. 
When,  on  the  other  hand,  there  was  no  absorption  of  the  vertebral 
cartilages,  considerable  stiffness  unaccompanied  by  deformity  was 
the  result.  A  large  number  of  ancient  Egyptians,  therefore,  were 
considerably  crippled,  the  majority  of  these  by  changes  in  the  verte- 
bral column,  and  a  minority  by  lesions  of  the  peripheral  articu- 
lations. 

The  pathological  lesions  in  the  dorsal  region,  though  not  con- 
ducive to  much  deformity,  were  very  important  on  account  of 
their  interference  with  respiration.  When  the  costo-vertebral 
articulations  were  attacked,  as  was  often  the  case  (Plate  XLIX, 
Fig.  2),  the  pain  on  respiration  must  have  been  extremely  severe, 
and  the  thoracic  movements  rendered  almost  impossible.  More- 
over, the  periarticular  lesions  of  the  costo-sternal  articulations 
undoubtedly  added  to  the  difficulties  in  respiration.  Abdominal 
respiration  also  was  occasionally  rendered  difficult  and  perhaps 
painful  by  the  lesions  on  the  anterior  surface  of  the  vertebrae  having 
involved  the  tendons  of  the  diaphragm. 

Respiration,  then,  was  difficult  and  painful,  but  must  have  been 
almost  impossible  whenever  any  bronchial  or  lung  attack  called  into 


214         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

play  the  muscles  which  are  only  used  in  forced  respiration,  the 
attachment  of  which,  as  has  been  shown  often,  were  extensively 
ossified.  Cough  was  extremely  painful,  and  any  disease  causing 
even  moderate  dyspnoea  must  have  proved  fatal  in  people  whose 
respiratory  muscles  were  unable  to  respond  to  the  extra  strain  put 
upon  them. 

The  lesions  of  arthritis  deformans  in  peripheral  joints  gave  rise 
to  pain,  limitations  of  movement,  etc.,  and  were  in  themselves  suffi- 
cient to  prevent  any  active  exertion  on  the  part  of  the  patient. 
When  the  temporo-maxillary  joint  was  attacked,  difficulty  in  tak- 
ing nourishment  became  an  important  and  distressing  symptom. 

In  a  paper1  on  the  lesions  of  teeth  in  ancient  Egyptians,  I  drew 
attention  to  the  very  common  occurrence  of  pyorrhoea  alveolaris 
in  people  with  spondylitis  and  other  manifestations  of  arthritis 
deformans,  and  dental  disease  added  to  the  joint  lesions  must  have 
rendered  the  patient's  life  well-nigh  unbearable. 

In  spite  of  these  serious  and  unsatisfactory  conditions  of  health, 
some  of  the  patients  lived  for  a  long  time.  Even  in  the  predynastic 
period  many  lived  long  enough  to  have  the  vertebral  column  anky- 
losed  from  end  to  end.  For  instance,  the  old  woman  from  Thebes,2 
whose  case  has  been  put  on  record,  was  certainly  confined  to  her 
bed  for  months  or  years  before  septic  poisoning  from  a  huge  bedsore 
proved  fatal  to  her. 

Every  Nubian  or  Egyptian  village  contained  within  its  walls  a 
fairly  large  number  of  people,  chronic  invalids,  who  could  do  little 
work,  and  a  few  completely  crippled  who  were  unable  to  earn  their 
living  by  agricultural  pursuits.  Some  may  have  engaged  in  light 
pursuits,  such  as  cooking,  tailoring,  etc.,  which  required  little  exer- 
tion, but  in  an  agricultural  community  only  a  very  small  proportion 
could  have  earned  their  living  in  that  way.  The  rest,  when  not 
wealthy,  were  dependent  on  the  charity  of  their  friends,  and  as  they 
lived  a  long  time  in  this  crippled  state,  it  follows  that  to  assist  one's 
friends  and  neighbours  was  already  a  duty  in  predynastic  times. 

1  Sir  Armand  Ruffer,  "Studies  in  Paleopathology :  Lesions  of  Ancient  Egyptian 
Teeth,"  Journal  of  Patliology  and  Bacteriology,  XVIII  (Cambridge,  1913-14),  149. 

2  Elliot  Smith,  "A  Contribution  to  the  Study  of  Mummification  in  Egypt," 
Memoircs  presentes  a  Vlnslitut  Egypticn,  Tome  V  (1906),  fasc.  1. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  215 

Lesions  such  as  we  have  described  could  not  have  occurred  in 
uncivilised  people,  for  the  patients  would  have  died  of  inanition 
before  the  changes  could  have  proceeded  so  far,  and  their  existence 
is  the  best  possible  proof  of  the  high  degree  of  civilisation  to  which 
ancient  Egyptians  had  attained. 

Chronic  articular  and  periarticular  disease,  therefore,  has  existed 
in  man  and  animals  for  many  thousands  of  years. 

In  this  paper  I  intend  to  give  an  account  of  chronic,  non- 
suppurating,  articular,  and  periarticular  disease  as  it  occurred  in 
Egypt  and  Nubia  during  the  last  eight  thousand  years  or  more. 

The  material  is  the  same  as  that  on  which  my  paper  on  the 
pathological  lesions  of  the  teeth  of  ancient  Egyptians  was  based, 
namely: 

1.  Skeletons  and  mummies,  dating  from  various  periods  of 
Egyptian  history,  given  me  by  the  late  Sir  Gaston  Maspero,  Pro- 
fessor Flinders  Petrie,  Mr.  Wainwright,  Professor  Breccia,  and  others. 

2.  The  large  collection  of  predynastic  and  later  skeletons  in  the 
Museum  of  the  Medical  School  of  Cairo. 

3.  Fragments  of  skeletons  from  Merawi  (Sudan)  and  Faras 
(Nubia),  kindly  handed  over  to  me  by  Professor  Griffith  (Oxford). 

4.  Skeletons  of  the  Macedonian  soldiers  buried  at  Chatby,  in 
Alexandria. 

5.  Skeletons  of  Alexandrians  (Greeks,  Egyptians,  etc.)  from  the 
catacombs  of  Kom  el  Shougafa  and  Ras  el  Tin. 

6.  Coptic  mummies. 

7.  Last,  but  not  least,  the  field  notes  of  Dr.  Wood  Jones,  pub- 
lished in  the  Archaeological  Survey  of  Nubia,  Vol.  II,  "Report  on 
Human  Remains,"  and  Professor  Elliot  Smith's  papers. 

The  existence  of  arthritis  deformans  and  spondylitis  in  ancient 
Egyptian  skeletons  has  been  noted  by  Elliot  Smith,  who  described1 
a  male  body  of  the  Ancient  Empire  from  the  Giza  pyramids  with 
complete  bony  union  of  every  vertebra  in  the  entire  column. 

Wood  Jones2  has  given  a  complete  and  excellent  account  of  this 
disease  as  it  existed  among  ancient  Nubians.     It  was  found  that  the 

'  Elliot  Smith,  Archaeological  Survey  of  Nubia,  Bull.  No.  2  (Cairo,  1908),  p.  59,  n. 
2  Wood  Jones,  Archaeological  Survey  of  Nubia,  1(107-8,  Vol.  II,  "  Report  on  Human 
Remains"  (Cairo,  1910),  273  f. 


216         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

disease  might  exist  in  every  joint,  including  the  temporo-maxillary 
articulation. 

Disease  of  the  knee-joint  was  perhaps  less  common  than  might 
have  been  expected.  He  states  that  in  by  far  the  greater  number  of 
affected  joints  (knee-joints)  eburnation  is  not  a  conspicuous  feature, 
whereas  the  irregularity  of  the  articular  surface  is  marked.  Wood 
Jones  says: 

It  would  seem  that  the  disease  may  take  one  of  two  forms:  one  in  which 
the  bony  outgrowth  and  a  great  roughening  of  the  articular  surfaces  are  the 
most  notable  features;  and  one  in  which  the  eburnation  of  the  opposed  ends 
of  the  bones  is  most  pronounced.  The  first  form  tends  in  a  very  great  number 
of  cases  to  bony  ankylosis  of  the  affected  joints. 

I  would  rather,  instead  of  speaking  of  two  forms  of  the  disease,  look 
upon  these  two  forms  as  two  "stages"  of  the  disease. 

He  describes  the  changes  found  in  the  elbow,  head  of  the 
humerus,  hands,  hips  (including  coxa  vara),  etc.,  and  points  out  that 
the  periarticular  changes  and  lesions  of  parts  of  the  bone  away  from 
the  joint  are  as  important  as,  if  not  more  important  than,  those 
in  the  articulations  themselves.  Further,  he  gives  a  very  accurate 
description  of  the  changes  found  in  spondylitis  deformans. 

In  several  cases  spondylitis  deformans  coexisted  with  arthritic 
disease  in  other  parts  of  the  body. 

Wood  Jones's  memoir  is,  further,  very  interesting  on  account  of 
the  field  notes  which  are  a  perfect  mine  of  information. 

The  type  of  the  disease  in  ancient  Egypt  was  distinctly  periph- 
eral; that  is,  the  chief  changes  were  in  the  ligaments,  the  capsules 
of  the  joints,  but  not  in  the  joints  themselves.  Whether  the  articu- 
lating surfaces  of  the  vertebral  column,  the  hip-joints,  knee-joints, 
or  the  smaller  joints  be  examined,  the  larger  number  of  cases  show 
no  alterations'  whatever  in  the  articulating  surfaces.  When  the 
latter  are  eburnated,  or  simply  show  signs  of  wearing,  as  in  the 
acetabular  cavity  of  the  hip-joint,  then,  in  every  case,  the  lesions  of 
the  disease  at  the  periphery  of  the  joint  were  intense,  and  the  lesions 
of  the  articular  surfaces  appeared  to  be  late  lesions  coming  after  the 
periarticular  changes  had  prepared  the  ground,  so  to  speak. 

Very  possibly  the  articular  lesions  during  life  were  very  marked 
and  left  but  little  trace  after  death.     Profound  changes  in  the 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  217 

synovial  membrane,  in  the  ligaments,  in  the  cartilages  even,  may 
have  been  conspicuous  in  the  living  and  yet  have  left  no  trace  in  the 
skeleton. 

All  that  can  be  said  for  certain,  therefore,  is  that  although,  very 
possibly,  the  articulations  and  articular  surfaces  during  life  may 
have  been  the  seat  of  extensive  lesions,  these  left  no  trace  after 
death  in  the  bony  structure.  The  peripheral  changes,  on  the  other 
hand,  were  extremely  marked  and  in  themselves  must  have  pro- 
duced extremely  severe  symptoms. 

The  question  now  arises  as  to  what  variety  of  arthritis  defor- 
mans, as  varieties  exist  now,  the  Egyptian  form  belongs. 

Thomas  M'Crae1  divides  arthritis  deformans  into  three  groups: 

1.  A  form  in  which  the  changes  predominate  in  the  structures,  apart  from 
the  bony  parts  of  the  joint,  although  the  cartilages  are  frequently  involved  to 
some  extent.  The  degree  of  change  varies  greatly.  This  group  is  termed 
"periarticular"  and  is  the  commonest  of  all. 

2.  A  form  in  which  the  chief  change  consists  in  marked  atrophy  of  both 
bones  and  cartilages.  With  this  there  are  usually  marked  atrophic  changes  in 
the  muscles.  This  is  termed  the  "atrophic"  form,  and  appears  to  be  com- 
paratively rare. 

3.  A  form  in  which  hypertrophic  changes  are  the  most  prominent.  There 
may  be  marked  bony  overgrowth,  which  may  occur  at  the  edges  of  the  articu- 
lating surfaces  especially,  or  in  the  spine,  involving  the  cartilages  and  ligaments. 
This  is  termed  the  "hypertrophic"  form,  and  is  commoner  than  the  second, 
but  not  as  common  as  the  first. 

These  forms,  however,  are  not  so  fixed  that  one  can  always  say 
with  certainty  that  a  given  case  belongs  to  one  group  rather  than  to 
another;  these  forms  may  pass  into  one  another.  Moreover,  it  is 
by  no  means  clear  what  is  meant  by  bony  overgrowths  at  the  edges 
of  the  articulating  surfaces,  or  in  the  spine,  involving  the  cartilages 
and  ligaments.  As  we  have  seen,  such  bony  overgrowths  (leaving 
out  the  cartilages)  are  common  in  our  cases,  but  they  appeared  to 
us  to  be  more  of  the  nature  of  a  deposit  of  bone  in  inflamed  tissue 
than  an  osseous  overgrowth  from  pre-existing  bone. 

Very  difficult,  also,  is  the  diagnosis  of  this  disease  in  the  spine. 
The  term  spondylitis  deformans,  which  I  have  used  throughout  this 
paper,  denotes2  an  arthritis  of  the  spinal  joints,  changes  in  them 

1  Osier  and  M'Crae,  System  of  Medicine,  VI,  505.         *  M'Crae,  op.  oil.,  p.  535. 


218         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

which  are  frequently  associated  with  proliferation  of  bone,  atrophy 
of  cartilages  with  its  replacement  by  bone,  and  osseous  changes  in 
the  ligaments.  These  last  are  apparently  involved  very  frequently, 
perhaps  the  anterior  lateral  ligament  most  often  of  all.  The  extent 
of  involvement  varies  greatly,  and  the  process  may  extend  along 
several  vertebrae,  making  practically  a  solid  column  for  some  dis- 
tance, or  a  process  of  one  vertebra  may  be  joined  to  that  of  the  next 
one.  The  transverse  processes  are  not  infrequently  involved.  The 
lesions  may  be  symmetrical  or  asymmetrical;  in  the  lower  spine  the 
process  is  frequently  most  marked  on  one  side,  in  the  cervical  region 
much  more  often  on  both  sides. 

This  condition  of  the  spine  may  be  the  only  manifestation  of 
spondylitis  deformans,  or  may  be  associated  with  arthritis  of  the 
peripheral  joints.  M'Crae  states  that  in  thirty-nine  out  of  eighty- 
one  cases  of  spondylitis  the  spine  alone  was  involved,  and  in  forty- 
two  this  was  associated  with  arthritis  elsewhere. 

He  also  maintains1  that  the  joints  of  the  vertebrae  may  be 
involved  in  a  general  polyarthritis,  and  apparently  need  not  be  de- 
scribed now,  as,  for  obvious  reasons,  the  pathological  changes  of  this 
polyarthritis  would  not  be  noticeable  in  skeletons. 

One  point,  which  is  not  usually  mentioned  in  the  papers  on 
spondylitis,  has  obtruded  itself,  and  that  is  the  very  important 
lesions  at  the  points  of  muscular  attachments  on  the  skeleton. 
These  lesions  in  some  parts  of  the  body,  as,  for  instance,  in  the  lum- 
bar and  pelvic  regions,  were  so  severe  that  they  must  have  crippled 
the  patient  almost  completely.  A  man  whose  vertebral  groove  was 
filled  with  ossified  muscles  would  have  had  a  "poker  spine"  even  in 
the  absence  of  any  other  lesions  (Plate  XLIX,  Figs.  3  and  4). 
Similarly,  the  man  whose  muscular  attachments  to  the  pelvic  or 
to  the  upper  part  or  lower  ends  of  the  femur  or  upper  end  of  tibia 
were  more  or  less  ossified  must  have  had  his  movements  consider- 
ably impaired.  The  lesions,  moreover,  which  are  seen  in  the  skele- 
tons are  probably  slight,  as  compared  with  those  which  existed 
during  life  but  left  no  trace  in  the  skeletons  after  death.  It  is  prac- 
tically certain  that  the  inflammatory  process  which  gave  rise  to 
roughness  and  osseous  deposits  at  the  point  of  attachment  of  the 

1  Op.  cit.,  p.  529. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  219 

muscles  spread  for  some  distance  along  the  tendon  and  even  into  the 
muscular  fibre.  When  both  ends  of  a  muscle  were  attacked,  as  was 
sometimes  the  case,  the  action  of  such  muscle  must  have  been  con- 
siderably interfered  with.  It  maybe  that  the  atrophy  of  muscles — an 
atrophy  which  does  not  appear  to  be  caused  by  mere  disuse — may 
be  due  in  some  cases  to  these  lesions,  but  there  is  no  proof  of  it; 
moreover,  the  fact  that  this  atrophy  is  sometimes  marked  in  cases 
in  which  the  chief  change  is  advanced  atrophy  of  bones  as  well  as 
cartilages — a  change  which  did  not  exist  in  our  cases — is  distinctly 
against  this  theory. 

On  the  other  hand,  the  involvement  of  the  muscles  may  perhaps 
account  for  the  severe  pains  of  obscure  origin  which  many  of  these 
patients  suffer  from.  It  seems  to  me  probable  that  many  cases  of 
so-called  muscular  rheumatism,  associated  or  not  with  arthritis 
deformans,  may  be  due  to  such  changes. 

The  lesions  of  the  vertebral  column  leave  no  doubt  regarding  the 
nature  of  the  disease.  The  cases  were  typical  cases  of  spondylitis 
deformans,  or  "poker  spine." 

The  only  difference  between  the  disease  in  modern  and  ancient 
people  lies  in  the  fact  that  in  modern  people  the  cartilages  are  often 
ossified,  whereas  in  the  few  mummies  examined  by  me  and  in  skele- 
tons no  evidence  of  ossification  of  the  cartilages  could  be  obtained. 

This  objection  is  probably  of  little  value,  for  several  reasons. 
In  the  first  place,  the  cases  in  which  the  cartilages  were  still  present 
were  so  few  that  no  conclusions  could  be  drawn.  In  the  second 
place,  marked  ossification  may  have  been  present,  but  unless  the 
cartilage  was  so  completely  ossified  as  to  form  a  solid  block, 
nothing  of  it  would  be  found  in  the  sand  more  or  less  filling  the 
grave. 

It  has  been  shown  in  the  course  of  this  paper  that  in  some  skele- 
tons there  were  distinct  signs  of  ossification  of  the  fibrous  part  of  the 
intervertebral  disc,  and  that  in  others,  especially  in  the  cervical 
region,  the  cartilages  had  evidently  been  absorbed  during  life — the 
vertebrae  falling  together.  It  is  evident,  therefore,  that  some  very 
serious  changes  had  taken  place  in  the  cartilages,  the  lesions  being  of 
such  a  nature,  however,  as  to  leave  no  trace  in  the  skeletons.  In  the 
(  ervi<  al  and  lumbar  regions  the  vertebrae  occasionally  fell  together, 


220         STUDIES  IN  THE  PALAE0PATH0L0GY  OF  EGYPT 

the  deformity  implying  a  disappearance  of  the  cartilages  through 
some  profound  pathological  change. 

The  disease  in  ancient  Egyptians  was  perivertebral  rather  than 
vertebral,  that  is,  as  in  modern  people,  the  ligaments,  and  more 
especially  the  anterior  common  ligament,  were  most  affected. 

The  material  at  our  disposal  was  not  such  as  would  easily  settle 
the  question  as  to  whether  the  spondylitis  deformans  was  or  was  not 
accompanied  by  arthritic  or  periarthritic  changes  in  other  parts  of 
the  body.  It  was  but  seldom  that  the  whole  skeleton  was  obtained, 
and  in  most  cases  only  a  few  bones  were  present,  so  it  was  not 
possible  to  say  whether  other  joints  besides  those  actually  dis- 
covered suffered  or  not. 

Certain  it  is,  however,  that  whenever  a  complete  skeleton  was 
discovered  with  lesions  of  spondylitis  deformans,  so  often  were  one 
or  more  of  the  distant  joints  affected.  In  many  cases,  therefore, 
spondylitis  was  complicated  by  peripheral  articular  disease,  as  it 
is  at  the  present  day. 

I.      MATERIAL   EXAMINED   AND   ITS   CHRONOLOGY 

The  first  skeleton  to  be  described  is  that  of  Nefermaat,  dis- 
covered by  Wainwright1  in  a  Illrd  Dynasty  mastaba  at  Meydum. 
The  tomb  had  been  rifled  at  the  time  of  burial  by  the  workmen,  who 
had  desecrated  the  body  and  considerably  damaged  the  skull  and 
many  of  the  bones. 

The  body  had  been  enclosed  in  a  coffin,  which  had  disappeared, 
and  some  time  after  burial  the  tomb  had  been  filled  with  mud  which 
had  penetrated  into  all  the  foramina  of  the  bones,  and  it  was  sup- 
posed that  the  body  had  been  first  dismembered  and  the  bones  then 
wrapped  up  in  bandages.  The  bones,  extremely  fragile,  were 
covered-with  thick  incrustations  of  salt,  and  the  mud  still  filled  all 
the  spinal  foramina  and  the  interstices  between  the  bones.  There 
was  nothing  to  show  that  the  salt  had  been  added  as  a  preservative, 
and  most  probably  it  had  crystallised  out  of  the  surrounding  mud 
and  been  deposited  on  the  bones  during  the  four  thousand  years  or 
more  which  had  elapsed  since  burial. 

■Wainwright,  "Meydum  and  Memphis,  III,"  Report  of  the  British  School  of 
Archaeology  in  Egypt,  1910. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  221 

The  spinal  column  from  the  fourth  cervical  vertebra  to  the  coccyx  had  been 
converted  by  disease  into  a  rigid  block,  which  at  some  time  or  other  after  death 
had  been  accidentally  broken  into  several  pieces. 

The  atlas,  axis,  and  third  cervical  vertebrae  were  absent.  The  first  piece 
consisted  of  the  cervical  vertebrae,  from  the  fourth  down  to  the  first  dorsal 
inclusively.  The  vertebrae  of  this  first  piece  were  firmly  tied  together  by 
solid  new  bone  which  had  developed  in  the  anterior  common  ligament,  and 
this  osseous  bridge  formed  a  distinct  arch  over  each  empty  intervertebral 
space.  The  intervertebral  discs  were  never  ossified,  the  surfaces  of  the  bodies 
of  the  vertebrae  were  smooth,  and  the  empty  intervertebral  spaces  were  not 
narrowed.  So  much  could  be  seen  through  the  gaps  left  here  and  there.  The 
posterior  common  ligament,  completely  ossified,  did  not  bulge  into  the  canal, 
and,  therefore,  did  not  press  on  the  spinal  cord.  Numerous  osteophytes 
developed  from  the  inferior-anterior  border  of  the  first  dorsal  to  form  a  bony 
bridge  with  similar  prolongations  from  the  superior  border  of  the  second 
dorsal  vertebra. 

The  whole  dorsal  region  displayed  similar  lesions,  the  anterior  and  posterior 
borders  of  the  vertebral  bodies  being  firmly  bound  together  by  the  ossified 
anterior  and  posterior  common  ligaments,  and  the  articulating  surfaces  with 
few  exceptions  solidly  united  by  periarticular  osseous  overgrowths.  Most  of 
the  spinous  processes  were  broken  off;  the  few  still  present  were  normal,  with 
the  exception  of  the  eleventh  and  twelfth,  which  were  connected  by  a  strong, 
bony  bridge. 

Similar  alterations  were  present  in  the  lumbar  region.  The  right  vertebral 
groove  opposite  the  twelfth  dorsal  and  first  and  second  lumbar  vertebrae  was 
filled  with  a  mass  of  somewhat  spongy  bone,  about  3  cm.  broad,  extending 
laterally  over  the  articulating  surfaces,  which  are  covered  everywhere  with 
thick  new  bone.  A  similar  mass,  somewhat  smaller,  occupied  the  left  verte- 
bral groove.  The  posterior  spinous  processes  were  not  ossified.  The  fifth 
lumbar  vertebra  was  firmly  fixed  by  new  bone  to  the  sacrum,  which  was 
otherwise  normal. 

The  pathological  changes  in  the  acetabula  were  limited  to  the  formation 
of  a  few  small  osteophytes  at  the  junction  of  the  articular  and  non-articular 
portions  (Plate  XLIX,  Fig.  5). 

The  head  of  the  right  femur  was  broken  off  post  mortem.  A  slight  deposit 
of  new  bone  at  the  junction  of  the  head  and  neck  showed  that  this  bone  also 
had  suffered.  The  lesions  of  the  right  femur  also  were  limited  to  slight  thick- 
ening of  the  anterior  border  of  the  articulating  surface  of  the  knee. 

The  scapulae,  which  were  the  only  bones  of  the  upper  extremity  that  were 
discovered,  were  healthy  except  for  some  very  slight  roughness  due  to  chronic 
inflammation  round  the  scapulo-humeral  articulations. 

The  manubrium  sterni  showed  curious  lesions.  On  the  right  side  the  first 
rib  was  firmly  ankylosed  with  it,  and  about  l§  inch  from  the  sternum  it  had 


222  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

evidently  been  badly  broken,  and,  owing  to  want  of  surgical  knowledge, 
perhaps,  a  false  joint  had  been  the  result  of  the  accident. 

Enough  of  the  costal  cartilages  was  left  to  prove  that  they  had  been 
completely  ossified. 

The  few  bones  of  the  skull  which  were  left  showed  no  alterations,  except 
that  the  internal  surfaces  of  both  condyles  had  been  rendered  uneven  by  old 
periarticular  inflammation. 

The  skeleton  of  this  man  therefore  exhibited  the  signs  character- 
istic of  severe  spondylitis  of  the  vertebral  column  throughout  its 
whole  length. 

The  lesions  were  especially  marked  in  the  anterior  and  posterior  vertebral 
ligaments,  but  whereas  in  the  former  the  inflammatory  process  had  led  to  the 
formation  of  large  bulging  osteophytes,  the  surface  of  the  latter  was  even  and 
smooth,  and  very  probably  therefore  the  spinal  cord  had  not  been  pressed 
upon.  The  intervertebral  discs  had  certainly  not  been  ossified,  and  the  upper 
and  lower  surfaces  of  the  bodies  were  apparently  free  from  disease. 

The  articular  surfaces,  on  the  other  hand,  were  practically  immobilised 
by  the  complete  ossification  of  the  fibrous  tissues  round  them,  and  all  these 
changes  had  made  the  whole  vertebral  column  incapable  of  flexion,  extension, 
or  lateral  movements.  This  condition,  sufficiently  serious  in  itself,  had  been 
aggravated  by  the  extension  of  the  disease  to  neighbouring  tendons  and  muscles. 
The  vertebral  groove  in  the  lumbar  region  being  filled  by  a  mass  of  spongy 
bone,  and  the  dorsal  and  cervical  regions  being  affected  by  lesions  similar, 
though  less  severe,  the  muscles  originating  from  the  lumbar  region — the 
latissimus  dorsi,  serratus  posticus  inferior,  spinalis  dorsi,  erector  spinae,  inter- 
spinal muscles,  etc. — have  been  considerably  interfered  with.  Similarly,  the 
attachments  of  the  dorsal  and  cervical  muscles  were  not  normal,  and  their 
efficiency  being  lessened  thereby,  the  movements  of  the  arms,  neck,  and  thorax 
were  certainly  rendered  more  difficult.  The  movements  of  the  head  also  had 
been  affected  by  the  extension  of  the  disease  to  the  internal  borders  of  the 
condyles. 

Respiration,  already  impeded  by  the  rigidity  of  the  vertebral 
column  and  the  pathological  changes  in  the  spinal  muscles,  was 
impeded  still  further  by  the  ossification  of  the  costo-vertebral  articu- 
lations and  costal  cartilages  and  by  the  old  fracture  of  the  first  right 
rib.  The  patient's  misery  had  been  increased  by  the  pain  accom- 
panying the  movements  of  the  pelvis,  hip-joints,  knee-joints, 
shoulder-joints,  and  of  several  other  articulations.  The  head,  neckj 
back,  and  limbs  were  motionless,  and  the  man,  unable  to  turn  round 
on  his  couch,  to  sit  up,  to  attend  to  any  necessities  of  life  without 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  223 

assistance,  was  a  typical  chronic  and  helpless  invalid  for  years 
before  death. 

Perhaps  in  this  case  the  disease  did  not  extend  to  the  smaller 
articulations,  in  contrast  to  the  following  case,  in  which  the  smaller 
articulations  had  been  undoubtedly  attacked.  The  fragments  of 
this  second  skeleton,  found  by  Professor  Flinders  Petrie  in  a  tomb  of 
the  Illrd  Dynasty  near  the  Fayoum  pyramid,  were  those  of  a  short 
adult,  whose  age  and  sex  are  not  ascertainable,  and  were  remarkable 
on  account  of  the  gravity  of  the  pathological  lesions. 

Some  osseous  overgrowth  existed  at  the  point  of  attachment  of  the  cervical 
transverse  ligament,  and  was  most  marked  on  the  left  side,  where  the  new 
bone  formed  a  kind  of  cushion  about  4  mm.  long,  3  mm.  broad,  and  3  mm. 
thick,  projecting  upwards  from  the  anterior  arch  on  the  same  side.  The 
tubercle  on  this  arch  was  greatly  thickened,  whereas  the  superior  articulating 
surfaces  were  normal.  The  odontoid  process  of  the  axis  was  very  irregular  in 
shape  and  was  capped  by  an  osteophyte  quite  5  mm.  long.  The  inferior- 
anterior  border  of  the  body  was  prolonged  into  a  spear-shaped  point.  The 
articulating  surfaces  were  normal. 

The  fourth  ( ?)  cervical  vertebra  was  much  thickened  round  the  body, 
especially  anteriorly.  The  inferior-anterior  border  sent  off  a  thick  prolongation 
downwards,  and  the  worm-eaten  and  rough  appearance  of  the  body  suggested 
that  there  were  some  pathological  changes  in  the  intervertebral  discs  also. 
The  cervical  vertebrae  (fifth  and  sixth)  were  firmly  joined  by  the  anterior  and 
posterior  common  ligaments.    The  disease  had  not  extended  to  the  articulations. 

Only  two  of  the  dorsal  vertebrae  were  found,  and  both  showed  great 
thickening  on  the  anterior  and  lateral  borders  of  the  body,  where  the  new 
bone  measured  as  much  as  4  mm.  in  thickness.  The  only  lumbar  vertebra 
present,  namely,  the  first,  had  a  mass  of  new  bone,  8  mm.  thick,  occupying 
the  superior  left  lateral  border. 

Only  one  metatarsal  bone  and  two  phalanges  were  discovered.  The 
metatarsal  bone  was  greatly  thickened  at  both  ends,  and  the  second  and 
terminal  phalanges  of  one  finger  were  firmly  ankylosed  in  a  fixed  position. 

The  pathological  changes  in  this  skeleton  resemble  those  of  the 
first.  The  anterior  and  posterior  common  and  periarticular  liga- 
ments were  ossified  throughout  the  whole  length  of  the  vertebral 
column,  and  the  articulations  of  the  smaller  bones  of  the  hand  and 
foot  of  the  second  skeleton  were  attacked  also.  The  disease  had 
probably  attacked  many  of  the  small  joints,  as  the  only  two  bones 
that  were  found  showed  severe  pathological  alterations. 


224         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Although  both  these  bodies  dated  only  from  the  Illrd  Dynasty 
(2980-2900  B.C.),  osteoarthritis  existed  long  before  that  period  in 
Egypt  and  in  Nubia. 

The  specimens  next  to  be  described  were  discovered  in  the 
necropolis  of  Kawamil,1  and  were  examined  by  my  friend,  the  late 
Dr.  Fouquet,  who  described  under  the  name  of  mat  de  Pott  the  typi- 
cal pathological  alterations  of  spondylitis  deformans. 

Kawamil  is  situated  515  km.  south  of  Cairo,  and  the  district 
contains  many  necropoles  and  kjoekken-moeddings  dating  from  the 
Neolithic  and  the  first  Pharaonic  periods.  Two  cemeteries  near  the 
village  of  Aoulad-Haroun  are  of  special  interest:  the  first  on 
the  north  side,  with  some  thousands  of  native  tombs  and  pottery 
characteristic  of  the  Neolithic  epoch;  the  other  more  to  the 
south,  with  graves  less  ancient,  containing  bodies  skeletonised 
before  inhumation  in  cysts  made  of  clay  or  crude  bricks,  or  in 
large  pots. 

Kjoekken-moeddings  with  worked  stone  implements,  fragments 
of  bones,  vases,  and  small  bronze  objects,  are  found  in  the  desert 
between  the  two  cemeteries,  and  one  little  hillock  is  made  up  of  an 
enormous  quantity  of  droppings  of  antelopes  and  gazelles. 

The  age  of  the  bones  discovered  at  Kawamil  is  therefore  some- 
what uncertain,  and  the  difficulty  is  increased  by  the  fact  that  in 
his  papers  Dr.  Fouquet  did  not  say  in  which  cemetery  the  bones 
described  by  him  were  found.  In  conversation,  however,  my  late 
friend  told  me  that  the  bones  came  from  the  predynastic  cemetery 
on  the  north.  An  estimate  of  six  thousand  years  for  the  age  of  these 
bones  is  therefore  not  exaggerated. 

The  bones  to  be  first  described  belonged  to  a  man  supposed  to 
have  been  approximately  forty  years  old  at  the  time  of  his  death. 
The  specimen  consisted  of  two  lumbar  vertebrae,  the  bodies  of  which 
were  strongly  united  by  massive  bilateral  bridges  of  bone  and  by  an 
anterior  median  band,  "separant  2  ouvertures  d'abces  par  conges- 
tion, dans  le  canal  desquels  on  apercoit  des  bourgeons  osseux  en  voie 
de  formation."  These  layers  of  new  bone  were  fairly  thick  with 
powerful  exostoses,  whereas  the  transverse  and  spinous  processes 
were  normal. 

1  De  Morgan,  Rcchcrches  sur  les  origines  de  VEgyplc,  Paris,  1897. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  225 

The  drawing  illustrating  Fouquet's  paper  shows  no  sign  what- 
ever of  an  "abces  par  congestion."  There  is  no  appearance  of 
ulceration  nor  of  any  lesion  of  the  bodies  of  the  vertebrae,  and  the 
new  bony  growth  is  confined  entirely  to  the  ligamentous  structures 
binding  together  the  vertebrae.  The  intervertebral  space  was  not 
narrowed,  and  appeared  to  be  normal. 

The  second  specimen  also  consisted  of  two  lumbar  vertebrae, 
enclosing  a  patent  and  not  narrowed  intervertebral  space.  The 
bodies  of  the  two  vertebrae  were  immobilised  on  the  right  side  by  an 
irregular  bony  bridge  and  by  a  similar  narrow,  smooth,  and  very 
prominent  bridge  on  each  side  in  front,  whereas  the  articular  surfaces 
were  fixed  by  irregular,  thin,  narrow,  osseous  bands.  The  vertebral 
bodies  were  solid  and  resistant  and  the  spongy  tissue  was  not  rare- 
fied. In  several  places,  and  especially  anteriorly,  there  were 
depressions  hollowed  out  by  small  vessels,  around  which  there  were 
doubtful  traces  of  suppuration.  The  specimen  apparently  came 
from  a  man  ( ?)  who  died  young.  The  third  specimen  also  presented 
lesions  similar  to  those  of  the  first,  that  is,  lesions  typical  of  spondy- 
litis deformans. 

On  the  whole,  therefore,  the  lesions  of  the  Kawamil  vertebrae, 
dating  from  the  epoch  of  chipped  flints,  greatly  resemble  those  of  the 
vertebrae  from  the  Illrd  Dynasty. 

The  remains  of  many  of  the  Nubian  skeletons  of  the  late  pre- 
dynastic  and  early  predynastic  periods  had  lesions  typical  of  spondy- 
litis deformans,  and  so  common  was  this  disease  in  early  Nubian 
epochs  that  "in  the  prehistoric  cemetery  in  the  main  street  of  Shellal 
near  Assuan,  no  adult  body  failed  to  show  some  traces  of  its  pres- 
ence." The  lesions  naturally  differed  greatly  in  severity,  varying 
from  a  mere  lipping  of  the  adjacent  edges  of  individual  to  the 
involvement  of  several  vertebrae,  and  even  to  the  ankylosis  of  a 
series  (Plate  XLLX,  Fig.  6) .  Very  commonly  two  or  more  lumbar 
vertebrae  of  prehistoric  skeletons  were  held  together  by  connecting, 
irregular,  osseous  bridges,  which,  however,  were  sometimes  limited 
to  one  side  of  the  anterior  surface  (Plate  XLLX,  Fig.  7). 

Proof  has  already  been  adduced  that,  in  Egypt,  the  disease 
appeared  very  early,  but  the  extent  of  its  spread  cannot  be  esti- 
mated.    For  example,  the  fifteen  predynastic  bodies  unearthed  in 


226         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Tourah,  near  Cairo,1  were  normal;  and  of  the  Illrd  Dynasty 
skeletons  from  the  same  place  only  one  showed  "lipping"  and 
"absorption"  of  the  vertebrae  from  the  second  cervical  vertebrae 
downwards.  The  old  pyramid  builders  paid  their  tribute  to 
spondylitis,  and  in  one  case  the  whole  spinal  column  was  found 
converted  into  a  solid  block. 

The  evidence  regarding  the  existence  in  the  Delta  of  this  disease 
in  very  ancient  times  is  not  forthcoming,  because,  for  obvious 
reasons,  ancient  skeletons  have  not  been  found  in  the  Delta;  but, 
considering  it  was  not  rare  in  that  part  of  the  country  during  the 
Greek,  Roman,  and  early  Christian  periods  and  is  fairly  common 
now,  it  is  more  than  probable  that  it  was  not  rare  during  the 
dynastic  era.  The  frequent  occurrence  of  spondylitis  deformans  in 
Nubia  during  the  early  periods  has  been  alluded  to  already,  but  it 
must  not  be  assumed,  as  has  been  done  more  than  once,  that  every 
Nubian  was  thus  afflicted. 

The  new  cemetery  (17)  at  Shellal,  for  instance,2  situated  on  the 
east  bank  of  the  river  at  Khor  Baha,  contained  the  remains  of  people 
of  the  early  and  middle  predynastic  times,  which  were  in  a  poor 
state  of  preservation,  and  skeletons  of  early  dynastic  times  (A  group) 
and  late  Ancient  Empire  periods  (B  group).  Of  the  one  hundred 
and  four  graves,  six  contained  fragments,  six  contained  children,  and 
three  were  occupied  by  dogs,  and  not  by  human  skeletons.  Four 
cases  of  spondylitis  were  found  in  the  eighty-nine  graves  remaining, 
and  of  these  one  had  arthritis  of  the  knee  and  other  articulations 
as  well. 

The  cemetery  of  Dabod  contained  a  series  of  archaic  remains, 
ranging  from  the  late  predynastic  period  on  to  the  Middle  Empire, 
and  a  group  of  bodies  dating  from  the  New  Empire. 

The  archaic  series  included  bodies  belonging  to  the  late  pre- 
dynastic and  early  dynastic  times  (A  group),  and  to  the  archaic 
Nubian  Middle  Empire  periods  (or  C  group),  and  the  characteristics 
of  these  bodies  closely  agreed  with  those  of  the  remains  of  similar 
dates  found  near  Shellal.     The   late   predynastic   and   A-group 

1  Derry,  Denkschrifl  d.  k.  Akad.  d.  Wissensch.  in  Wien,  191 2. 

2  Elliot    Smith    and   Wood    Jones,    Archaeological    Survey    of   Nubia,    igoy-S, 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  227 

skeletons  conformed  to  the  predynastic  Egyptian  type,  whereas  the 
archaic  and  middle  Nubian  people  had  been  evidently  tinged  with 
Negro  blood. 

An  analysis  of  the  notes  showed  that  in  thirty-four  undated 
graves  three  skeletons  showed  lesions  of  spondylitis.  The  lesions  of 
the  vertebrae  were  complicated  by  osteitis  of  the  pelvis  and  arthritis 
of  the  knees  in  one  case,  and  by  arthritis  of  the  metatarsals  in 
another. 

After  a  large  number  of  burials  had  been  eliminated,  because 
they  contained  either  children  or  animals,  there  were  left:  twenty- 
five  archaic  bodies  with  ten  cases  of  spondylitis;  seven  middle 
Nubian  bodies  with  two  cases  of  spondylitis;  twenty-seven  New 
Empire  bodies  with  three  cases  of  spondylitis. 

Forty  per  cent  of  the  archaic  inhabitants,  therefore,  had  been 
attacked  by  spondylitis,  sometimes  complicated  by  other  severe 
arthritic  lesions,  such  as  arthritis  of  the  knee  (Plate  L,  Fig.  8)  and 
osteitis  of  the  pelvis,  arthritis  of  the  left  shoulder-joint  (Plate  L, 
Fig.  9) ,  accompanied  by  great  eburnation,  and  ankylosis  of  the  pel- 
vis (Plate  L,  Fig.  10). 

Cemetery  30,  on  the  eastern  side  of  the  river,  included  skeletons 
from  the  middle  predynastic  and  early  dynastic  periods,  and  from 
the  Middle  Empire  C  group  and  the  New  Empire  group.  The  pre- 
dynastic bodies  were  in  a  fair  state  of  preservation,  in  contrast  with 
those  of  C  group  and  New  Empire  date,  which  were  not  so  useful 
for  our  purpose. 

The  New  Empire  graves  need  not  be  considered,  as  there  are  no 
notes  concerning  them ;  four  cases  are  also  useless  for  other  reasons ; 
and  there  remain  notes  of  five  archaic  skeletons,  of  which  three  had 
spondylitis,  and  of  twelve  middle  Nubian  bodies  with  four  cases  of 
spondylitis. 

Cemetery  40  included  burials  from  the  early  dynastic,  New 
Empire,  and  Christian  periods,  but  the  notes  of  the  early  dynastic 
series  alone  are  available  for  our  purpose.  Of  the  twenty-nine 
bodies  mentioned,  two  must  be  eliminated,  and  there  are  then  left 
twenty-seven  skeletons  with  nine  cases  of  spondylitis. 

The  incidence  of  this  disease  during  predynastic  and  dynastic 
times  in  Upper  Egypt  is  not  known,  but  for  reasons  to  be  explained 


228         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

afterwards  it  can  be  assumed  that  the  incidence  was  probably  very- 
great. 

It  will  be  convenient  here  to  study  this  disease  as  it  appeared  in 
Nubia  and  in  Alexandria  during  the  period  beginning  at  the  time  of 
the  Greek  occupation  332  B.C.  to  about  300  a.d.,  that  is,  roughly 
six  hundred  years.  The  huge  gap  this  left  in  our  historical  study 
will  be  filled  up  later  on,  as  far  as  possible. 

The  examination  of  the  mummies  found  in  Cemetery  3,  on  the 
island  of  Hesa,  in  Nubia,  gives  an  idea  of  the  conditions  prevailing  in 
Nubia  during  the  Ptolemaic  period.  The  mummies  had  been  put 
into  coffins  of  stone  or  pottery,  which  had  been  buried  in  chambers 
carved  out  of  a  granite  hill.  The  bodies  were  those  of  the  priests  of 
Philae  and  of  their  women  and  children,  who  lived  during  the 
second  or  third  century  B.C.  The  information  concerning  the 
pathological  lesions  in  these  people  is  not  very  satisfactory,  as,  owing 
to  the  bad  preservation  of  the  bodies,  complete  examination  of  them 
was  impossible.  Still,  the  fact  remains  that  five  skeletons  with 
spondylitis,  sometimes  very  severe,  were  found  among  sixty-four 
skeletons  examined. 

Farther  south,  in  a  Roman  cemetery  (14),  which  contained 
but  few  bodies,  several  skeletons  with  spondylitis  were  discovered. 
A  young  man,  whose  lumbar  vertebrae  showed  much  lipping,  had 
also  characteristic  arthritis  of  the  knee  and  elbow.  Two  lumbar 
vertebrae  of  another  man  with  extreme  spondylitis  were  firmly 
ankylosed,  and  he  had  suffered  also  from  some  inflammatory  pro- 
cess in  both  tibiae  and  fibulae. 

In  the  Romano-Nubian  group  (X  group)  of  Cemetery  13,  situ- 
ated higher  up  on  the  river  and  dating  approximately  from  the 
second  to  sixth  century  a.d.,  several  cases  of  spondylitis  were 
found. 

On  the  west  bank  of  the  Nile,  opposite  the  island  of  Markos,  the 
field  notes  referring  to  a  group  of  twenty-four  bodies  (Cemetery 
42),  dating  from  the  Byzantine  period,  mention  one  case  of  extreme 
spondylitis  and  one  of  arthritis  of  the  knees. 

A  few  personal  observations  made  at  Meroe  in  the  Sudan  and  at 
Faras  may  be  mentioned  here,  although  they  refer  to  a  somewhat 
earlier  period,  namely,  to  that  of  the  Meroitic  kingdom. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  229 

During  the  winter  of  1913,  the  writer  had  an  opportunity  of 
witnessing  for  a  few  days  the  excavations  then  in  progress  at  Merawi 
(Sudan) .  Professor  Griffith,  of  Oxford,  who  was  directing  the  work, 
gave  every  facility  for  studying  the  skeletons  still  in  the  graves,  and 
the  skulls  and  bones  which  he  had  collected  at  Merawi,  and  also  the 
specimens  which  he  had  dug  up  at  Faras  in  1912. 

Merawi  is  situated  on  the  Nile  (180  N.)  close  to  the  ancient 
Napata,  and  must  not  be  mistaken  for  another  village  of  the  same 
name  which  is  situated  farther  south;  Faras  lies  a  few  miles  north 
of  Wady  Haifa,  not  far  from  the  Second  Cataract  of  the  Nile. 

At  Merawi,  owing  to  the  very  bad  state  of  the  bones,  no  case  of 
arthritis  was  met  with,  until  at  length  three  lumbar  veretebrae  with 
marked  lipping  of  the  anterior  borders  of  the  bodies  were  found  in  one 
grave.  Two  lumbar  vertebrae  in  another  grave  showed  some  lip- 
ping of  their  borders,  and  were  held  together  on  one  side  by  a  strong 
bridge  of  new  bone,  measuring  about  15  mm.  in  width  and  about 
5  mm.  in  thickness. 

At  Faras,  the  vertebrae  were  very  few  and  badly  preserved. 
Three  sacra,  however,  showed  signs  of  spondylitis  deformans.  The 
disease,  therefore,  existed  at  Merawi  and  Faras,  two  of  the  hottest 
and  driest  places  in  the  world. 

The  skeletons  from  Alexandria,  with  the  coldest  and  wettest 
climate  of  Egypt,  came  from  many  graves  and  belonged  to  various 
nationalities. 

The  first  part  of  this  material  was  found  at  Chatby,  near 
Alexandria,  about  two  minutes'  walk  from  the  sea,  in  the  tombs  of 
the  Macedonian  soldiers  of  Alexander  the  Great  and  Ptolemy  I.  In 
view  of  the  constant  growth  of  the  modern  town,  which  will  soon 
extend  over  the  whole  of  this  region,  the  Municipal  Commission 
ordered  an  archaeological  survey  of  this  site.  The  work  was 
entrusted  to  Professor  E.  Breccia,  who  gave  Dr.  Rietti  and  myself 
permission  to  examine  most  of  the  bones  found  in  the  necropolis  and 
to  be  present  during  the  excavations.  Professor  Breccia  has  since 
given  a  full  account  of  his  work  in  two  magnificent  volumes.1 

Owing  to  a  lawsuit,  the  work  has  been  suspended  for  a  time;  this 
delay  i     pecially  unfortunate,  because  the  names  of  the  tombs  to  be 

'  E.  Hrcccia,  Le  nccropoli  di  Scialbi. 


230         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

yet  opened  indicate  that  these  contain  the  skeletons  of  the  ladies  of 
pleasure  who  accompanied  the  Greek  army.  Here,  if  anywhere, 
evidence  of  gonorrhoea  and  syphilis  should  be  found,  if  venereal 
disease  really  existed  at  that  period. 

The  bodies  were  in  rock-hewn  graves,  the  first  grave  being  an 
ossarium,  measuring  about  2  cm.,  filled  with  sand  and  bones,  and 
closed  with  a  stone  slab,  the  edges  hermetically  sealed  with  mortar. 
The  bones,  after  the  bodies  had  undergone  decomposition  elsewhere, 
had  been  thrown  pell-mell  into  the  ossarium,  and  evidently  little 
care  had  been  taken,  for  the  femur  of  a  horse  was  found  among  the 
human  bones. 

The  other  sepulchres  were  horizontal  shafts,  3 . 5  feet  high,  6  feet 
deep,  and  about  3 . 5  feet  wide,  cut  into  the  sandstone  rock  in  the 
same  manner  as  the  ossarium.  Very  rarely,  such  a  tomb  contained 
but  one  body  lying  on  a  layer  of  sand  about  6  inches  deep ;  as  a  rule, 
several  skeletons,  five,  six,  or  even  more,  were  present.  The  small 
size  of  the  shafts  was  proof  positive  that  the  bodies  had  not  been 
put  in  together,  and  that  putrefaction  had  destroyed  the  soft  parts 
of  the  first  body  before  the  second  had  been  introduced. 

Funereal  urns  filled  with  ashes  or  half-carbonised  bones  were  also 
discovered.  The  Greeks  of  that  period,  therefore,  were  eclectic  in 
their  customs,  some  families  burying,  others  burning  their  dead. 

Unfortunately,  the  level  of  the  land  had  sunk  several  feet  since 
the  last  inhumation.  Hence  some  tombs  were  partially  filled,  others 
merely  infiltrated  with  sea  water,  and  the  bones  were  often  found 
lying  in  thick,  wet  mud.  Such  skeletons  were  in  very  bad  condition, 
and  most  of  the  smaller  and  some  of  the  larger  bones  could  not  be 
found,  even  when  the  slush  was  removed  carefully  by  hand;  but 
although,  as  might  be  expected,  the  bones  in  dry  graves  were  natur- 
ally rather  better  preserved  than  those  in  a  wet  bed,  yet  this  was  by 
no  means  the  rule.  The  skeleton  of  a  female,  for  instance,  lying  on 
a  bed  of  dry  sand,  was  so  fragile  that  some  of  the  bones  were  broken 
when  their  careful  removal  was  attempted ;  on  the  other  hand,  bones 
lying  in  liquid  mud  were  sometimes  very  hard,  while  others  from  the 
same  grave  broke  as  soon  as  touched. 

Sometimes  the  soldiers  had  been  buried  with  their  wives  and 
children.     It  is  much  to  be  regretted  that  infantile  skeletons  were 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  231 

useless  for  pathological  research,  as  hardly  a  single  one  of  their  bones 
was  preserved  sufficiently  well  for  examination. 

A  superficial  examination  sufficed  to  show  that  various  races  were 
represented.  Some  of  the  thirty-two  skulls  examined  had  high- 
bridged  noses,  others  remarkably  flat  ones;  some  were  brachy- 
cephalic,  others  markedly  dolichocephalic,  and  two  were  evidently 
negroid.  The  variations  in  stature  were  also  considerable,  some 
men  being  very  tall,  others  small.  These  differences  are  not  to 
be  wondered  at  considering  that  from  the  start  Alexander's 
army  was  distinctly  a  "mixed"  crew.  Of  the  30,000  foot  sol- 
diers who  left  Greece  with  Alexander,  only  12,000  were  Greeks 
(Smith's  Classical  Dictionary);  the  others  were  foreigners,  chiefly 
Thracians. 

It  is  highly  probable  that  the  Greek  and  foreign  soldiers  settled 
in  Egypt  had  intercourse  with  and  often  married  native  women,  just 
as  their  successors  have  done  in  modern  times.  The  present  Ber- 
berine,  especially  when  coming  from  Korosko,  often  boasts  that  he 
is  a  descendant  of  a  Turkish  soldier  and  a  native  woman;  and  the 
term  Turk,  as  used  by  the  Berberine,  includes  Greek,  Herzego- 
vinian,  Bosnian,  Bulgarian,  and  Serbian — in  fact,  any  one  who  has 
served  in  the  Turkish  army.  Similarly,  the  population  of  Alex- 
andria under  the  Ptolemies  included  Macedonians,  Greeks,  Syrians, 
Jews,  Persians,  etc.,  and  the  nucleus  for  the  future  population  of 
Alexandria  already  existed  in  Alexander  the  Great's  time. 

Mahaffy  draws  special  attention  to  the  false  impression  given  by 
most  authors  that  Alexandria  was  a  city  in  which  the  Jews  and 
Greeks  counted  for  everything,  the  natives  for  nothing.  On  the 
contrary,  the  majority  of  the  poorer  classes  was  from  the  beginning 
Egyptian,  and  to  the  last  the  city  remained  very  different  from 
other  Hellenistic  foundations.  The  native  element,  though  at  first 
thrust  out  from  power  and  influence,  gradually  reasserted  itself,  and 
the  city  that  opposed  Caesar  was  probably  far  more  Egyptian  than 
that  which  opposed  Antiochus  Epiphanes. 

Old  Alexandria,  therefore,  may  be  compared  to  the  modern  town, 
where,  although  the  greater  part  of  the  wealth  and  power  is  in 
the  hands  of  the  Europeans,  any  law  repugnant  to  native  ideas  or 
customs  speedily  becomes  a  dead  letter. 


232         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  extent  of  intermarriage  between  the  various  people  inhabit- 
ing Alexandria  cannot  be  estimated,  but  that  they  did  live  in  very- 
close  association  is  shown  by  the  fact  that,  during  the  Roman  period, 
many  inhabitants  had  two  names,  one  Egyptian  and  the  other 
foreign. 

The  possible  influence  of  race  and  environment  on  the  pathology 
of  ancient  Egypt  may  perhaps  be  discussed  on  another  occasion,  but 
these  few  lines  suffice  to  prove  that  an  attempt  to  unravel  this 
question  by  the  study  of  material  collected  in  Alexandria  can  lead  to 
no  practical  conclusion. 

The  catacombs  of  Kom  el  Shougafa,  situated  close  to  Pompey's 
pillar  at  Alexandria,  date  from  the  second  century  a.d.,  and  most  of 
the  skeletons  were  those  of  the  members  of  a  mixed  Graeco-Egyptian 
population.  The  tombs  contained  hundreds  of  skeletons,  most  of 
which,  owing  to  the  gradual  infiltration  of  water,  were  practically 
useless  for  our  purpose.  The  supposition  that  these  catacombs 
contained  the  skeletons  of  the  Alexandrian  youths  massacred  by 
Caracalla  is  disproved  by  the  fact  that  many  skeletons  were  those 
of  women  and  children. 

The  mode  of  burial  was  almost  identical  with  that  at  Chatby. 
The  first  body  had  been  placed  on  a  layer  of  sand  about  4  inches 
thick,  and  later  on  it  had  been  pushed  aside  to  make  room  for  a 
second  occupant.  The  loculi  contained  fragments  of  eight  and  ten 
bodies,  and  as  the  size  of  the  tombs  precludes  all  possibilities  of 
more  than  two  or  at  most  three  bodies  having  been  buried  at  any  one 
time,  it  follows  that  this  process  had  been  repeated  more  than  once. 
So  far  the  writer  has  seen  no  trace  of  cremation  or  mummification 
at  Kom  el  Shougafa. 

In  191 2  very  few  of  the  skeletons  had  been  examined  for  patho- 
logical lesions.  Since  then,  fragments  from  over  150  adults  have 
been  studied,  but  the  state  of  the  skeletons  was  such  that  not  a 
single  skull  could  be  reconstructed.  Some  of  the  loculi  had  been 
rifled  by  tomb  robbers  in  ancient  times  and  by  modern  archaeolo- 
gists, and  in  both  cases  the  result  had  been  the  same :  the  bones  had 
been  thrust  aside  into  a  heap  in  one  corner  of  the  tomb  and  most  of 
them  had  been  broken.  No  statistics,  therefore,  were  available, 
concerning  the  incidence  of  any  disease. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  233 

At  Ras  el  Tin,  in  a  garden  of  His  Highness  the  Sultan's  palace, 
a  workman  engaged  in  sinking  a  well  suddenly  slipped  into  a  cata- 
comb in  which  many  hundreds  of  bodies  had  been  placed.  This 
catacomb  is  made  up  of  a  number  of  passages,  lined  on  each  side 
with  loculi  containing  skeletons.  A  full  archaeological  account  will 
be  given  later  on  by  the  curator  of  the  Alexandria  Museum,  who 
allowed  me  to  remove  some  of  the  bones  in  the  short  time  during 
which  the  underground  passages  remained  open. 

Archaeological  observations  make  it  certain  that  the  people 
buried  there  were  Egyptians,  and  that  the  tombs  date  from  the  days 
of  Cleopatra.  The  Egyptian  origin  of  the  skeletons  is  confirmed  by 
the  fact  that  most  of  the  bodies  had  been  embalmed,  for  the  major- 
ity of  the  skulls  had  been  perforated  for  the  removal  of  the  brain, 
according  to  the  classical  Egyptian  method.  Remnants  of  embalm- 
ing material  were  entirely  absent,  except  for  a  few  very  small  frag- 
ments of  plaster  masks  and  mummy  cases,  and  some  small  amount 
of  gummy  material  in  a  few  skulls.  The  bandages  wrapped  round 
the  body  had  not  been  proof  against  the  dissolving  action  of  the  wet 
sand,  which  in  the  course  of  twenty  centuries  had  filled  the  cata- 
combs. This  state  of  things  is  to  be  regretted,  the  more,  since 
practically  nothing  is  known  of  the  methods  of  the  embahner's 
craft  in  the  Delta;  but  as  the  embalming  material  disappeared 
quickly  it  probably  consisted  of  some  easily  putrescible  substance 
such  as  linen,  and  not  of  earth,  sand,  resin,  pitch,  bitumen,  nor  any 
resistant  vegetable  matter.  Whatever  the  method  may  have  been, 
it  proved  a  complete  failure. 

The  loculi  were  roughly  6  feet  long  and  3  feet  high,  and  five  or  six 
perforated  skulls  and  the  remains  of  a  like  number  of  skeletons  were 
discovered  in  some.  By  no  amount  of  force  could  such  a  number  of 
bodies  have  been  squeezed  into  that  space;  clearly,  therefore,  the 
first  and  second  mummified  bodies  had  fallen  to  pieces  before  the 
third  and  any  of  the  others  were  introduced.  Another  unavoidable 
conclusion  is  that  the  loculi  were  in  use  for  a  fairly  long  time,  some 
centuries  possibly. 

Spondylitis  deformans  was  obviously  very  common  among  the 
people  buried  at  Chatby,  though,  for  reasons  just  explained,  this 
conclusion  1  annot  be  based  on  accurate  statistics.     The  thirty-two 


234         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

skulls  found  do  not  represent  the  truth,  and  a  larger  number  were 
undoubtedly  buried,  as  the  number  of  skulls  does  not  agree  with  that 
of  the  mandibles  or  right  femurs.  Judging  from  the  number  of  the 
latter,  it  is  certain  that  at  least  forty  adults  or  fragments  of  forty 
adult  bodies  were  put  to  rest  in  the  graves  examined  at  Chatby. 

One  complete  skeleton  was  obtained.  It  was  that  of  a  young 
woman  whose  third  molars  had  not  quite  emerged,  and  was  in  a  very 
bad  state  of  preservation,  the  skull  and  smaller  bones  falling  to 
pieces  when  a  careful  attempt  was  made  to  remove  them.  The 
whole  spinal  column  from  end  to  end  showed  early  signs  of  spondy- 
litis deformans,  namely,  overlapping  of  the  anterior  borders  of  the 
vertebrae,  and  enlargement,  eburnation,  and  ankylosis  of  the  articu- 
lating surfaces. 

In  other  graves  many  vertebrae  were  found  ankylosed,  or,  when 
separate,  in  such  a  position  that  there  could  be  no  doubt  that  they 
belonged  to  the  same  body.  A  few  typical  examples  of  these  lesions 
are  now  given. 

Ankylosis  of  the  articulating  surfaces  between  the  axis  and  the  third 
cervical  vertebra  was  the  characteristic  lesion  of  one  skeleton.  Moreover,  the 
posterior  borders  of  the  bodies  were  firmly  bound  together  by  new  bone  which 
had  developed  in  the  posterior  common  ligament.  The  odontoid  process  was 
very  rough,  especially  at  the  lower  borders  of  the  groove  for  the  transverse 
ligament,  and  its  rough  and  asymmetrical  tip  was  capped  with  newly  formed 
bone  (Plate  L,  Fig.  n).  The  inferior  articulating  surface  of  the  third  vertebra 
was  greatly  enlarged  and  surrounded  by  osseous  outgrowth,  and  a  long  spur 
of  bone  projected  from  the  inferior-anterior  border  of  the  body. 

The  third,  fourth,  and  fifth  cervical  vertebrae  of  another  skeleton  were 
firmly  joined  together.  The  upper  and  lower  borders  of  the  bodies,  especially 
those  of  the  sixth,  though  somewhat  thickened,  were  otherwise  practically 
normal.  The  disease  was  chiefly  confined  to  the  articular  surfaces,  which 
with  two  exceptions  were  almost  double  their  normal  width,  flattened  and 
fixed  to  one  another  by  thick  new  bone. 

Similar  changes  disfigured  the  dorsal  region  of  many  spinal 
columns.     One  osseous  block  consisted  of  three  dorsal  vertebrae. 

The  upper  border  of  the  body  of  the  highest  vertebra  was  thickened, 
especially  in  front,  where  the  new  bone  was  at  least  5  mm.  thick.  The  right 
lower  border  had  thrown  out  a  flat  osteophyte,  10  mm.  long  and  20  mm.  broad, 
which  met  another  osteophyte  projecting  upwards  from  the  vertebra  below, 
and  the  upper  and  lower  articulating  surfaces  were  very  rough,  irregular,  and 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  235 

enlarged.  Similar  lesions  were  present  in  the  next  vertebra,  and,  further,  the 
border  of  the  surface  articulating  with  the  tubercle  of  the  rib  was  deformed. 
The  roughened  superior-anterior  border  of  the  last  vertebra  had  thrown 
out  a  strong  osteophyte  which  met  a  similar  projection  from  the  preceding 
vertebra.  The  superior  and  inferior  articulating  surfaces  showed  all  the 
changes  characteristic  of  spondylitis  deformans.  The  costo-vertebral  articulat- 
ing surfaces  were  enlarged,  rough,  and  almost  worn  away. 

Such  ankylosed  masses  were  of  common  occurrence,  and  the 
large  majority  of  the  dorsal  and  lumbar  vertebrae  showed  more  or 
less  profound  inflammatory  changes.  Two  lumbar  vertebrae,  for 
instance,  were  firmly  bound  together  by  a  strong  mass  of  new  bone 
extending  right  round  the  bodies  of  both,  and  strong  prolongations 
at  each  extremity  proved  that  the  disease  extended  to  the  verte- 
brae both  above  and  below. 

The  disease  also  attacked  the  sacrum  and  pelvis.  Firm  anky- 
losis between  the  sacrum  and  the  right  iliac  bone  existed  in  two 
cases,  and  in  two  others  the  fifth  lumbar  vertebra  and  the  sacrum 
were  firmly  joined  by  strong  osteophytes.  In  another  skeleton  a 
strong  osteophyte  extended  upwards  from  the  left  anterior-superior 
border  of  the  sacrum  to  the  fifth  lumbar  vertebra. 

Typical  spondylitis  deformans,  therefore,  existed  among  the 
Greeks  and  other  settlers  in  Egypt  at  the  time  of  the  Ptolemies. 

The  manifestations  of  the  disease  in  the  mixed  population  buried 
at  Kom  el  Shougafa  were  not  less  interesting.  Two  tombs  contain- 
ing eight  adult  bodies  were  examined  in  the  first  investigations  of 
this  catacomb,  and  no  less  than  four  skeletons  exhibited  typical 
lesions  of  spondylitis  deformans. 

One  skeleton  resembled  that  of  the  IHrd  Dynasty  described  above,  the 
whole  vertebral  column  having  been  converted  into  a  rigid  block.  The 
anterior,  posterior,  and  lateral  common  ligaments  in  the  cervical  and  lumbar 
regions  were  so  completely  ossified  that  a  glimpse  into  the  intervertebral 
spaces  was  obtainable  here  and  there  only.  Similarly,  all  movements  of  these 
regions  were  arrested  owing  to  the  articulating  surfaces  being  tightly  held  by 
dense  new  bone.  The  spinous  processes  of  the  cervical  vertebrae  were  normal, 
whereas  those  of  the  lumbar  vertebrae  were  connected  by  a  strong  bridge 
of  bone  which  had  developed  in  the  supraspinous  ligament.  The  lesions  of 
the  dorsal  region,  though  severe,  were  on  the  whole  less  serious  than  those 
'  r  parts  of  the  vertebral  column.  The  limitation  of  movements  due  to 
the  strong  osseous  bridges  connecting  the  bodies  of  the  vertebrae  anteriorly 


236         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

was  undoubtedly  very  great,  but  there  was  not  that  complete  ossification  of 
all  the  ligaments  which  was  conspicuous  both  above  and  below  that  region. 
In  fact,  the  borders  of  the  bodies  of  the  dorsal  vertebrae  were  free  from  disease 
for  more  than  two-thirds  of  their  lengths.  The  articulating  surfaces  also  were 
not  so  tightly  bound  together,  though  bony  excrescences  due  to  severe  inflamma- 
tion were  conspicuous.  The  costo-central  and  the  costo-transverse  articulating 
surfaces  were  normal,  whereas  the  periarticular  ligaments  were  ossified  more 
or  less  completely. 

Other  tombs  of  Kom  el  Shougafa,  cleared  in  1913,  yielded  the 
fragmentary  remains  of  over  two  hundred  adults,  and  ten  axis 
vertebrae,  out  of  forty  which  were  collected,  showed  distinct  patho- 
logical changes.  The  articulating  surface  of  the  odontoid  process 
with  the  atlas  was  sometimes  enlarged  and  sometimes  eburnated, 
the  tip  was  often  capped  by  new  bone,  very  irregular  in  shape,  and 
sometimes  curved  like  a  Phrygian  cap. 

The  sacrum  was  affected  by  osteo-arthritis  in  the  same  pro- 
portion, namely,  25  per  cent,  and  the  proportion  of  diseased  cervical, 
dorsal,  and  lumbar  vertebrae  was  nearly  40  per  cent. 

The  contemporaries  of  Cleopatra  buried  at  Ras  el  Tin,  two 
centuries  previously,  were  similarly  affected.  The  whole  lumbar 
and  dorsal  vertebrae  of  one  case  were  firmly  bound  together  by 
osseous  bridges,  and  in  consequence  the  curvature  of  the  vertebral 
column  was  such  that  the  patient  must  have  been  doubled  up  when 
he  stood  (Plate  XLIX,  Fig.  3).  More  probably,  however,  he  could 
not  stand  up  at  all.  Numerous  osseous  blocks  were  found  consisting 
of  two,  three,  or  more  vertebrae  from  various  parts  of  the  vertebral 
column  (Plates  L  and  LI,  Figs.  12  and  13),  and  from  an  examination 
of  a  considerable  number  of  fragments  the  conclusion  was  reached 
that  the  incidence  of  this  disease  was  not  less  than  30  per  cent  and 
was  probably  somewhat  higher. 

About  eighty  miles  west  of  Alexandria,  the  traveler  finds  the 
ruins  of  the  ancient  sanctuary  of  Abou  Menas,  which,  during  the 
early  Christian  period,  was  a  pilgrimage  place  visited  by  sufferers. 
The  crowds  of  sick  pilgrims  brought  back  to  their  friends  holy  water 
contained  in  special  bottles,  which  have  been  discovered  as  far  as 
Mainz  in  Germany,  and  in  England,  France,  etc.,  and  this  fact 
clearly  proves  the  high  esteem  in  which  the  Abou  Menas  water  was 
held.     The  exact  date  of  the  foundation  of  this  ancient  Lourdes  is 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  237 

not  known,  but  it  was  certainly  not  later  than  the  fourth  century 
a.d.,  and  the  popularity  of  the  shrine  lasted  until  its  destruction  by 
the  Arabs. 

The  archaeologist  who  brought  these  ruins  to  light,  laboriously 
noted  every  bit  of  glazed  pottery  or  fragment  of  stone,  etc.,  which 
littered  the  site,  and  recorded  his  observations  in  a  very  elaborate 
illustrated  work.  His  soul,  however,  was  clearly  above  such  trifling 
things  as  human  remains,  for,  one  year  after  he  had  left,  a  number  of 
skulls,  vertebrae,  and  limb  bones  were  found  thrown  about  the  pas- 
sages and  elsewhere,  but  most  of  the  contents  of  the  graves  are  lost 
forever.  A  similar  state  of  things  exists  at  Abou  Sir,  where  the 
graves  near  the  sea,  dating  from  a  perhaps  slightly  earlier  period, 
have  also  been  rifled  almost  completely.  A  few  bones  alone  had 
been  left  in  situ  by  the  tomb  robbers. 

This  neglect  is  all  the  more  regrettable  in  that  many  skeletons 
must  have  been  those  of  patients  who  suffered  from  some  chronic 
disease  for  which  they  had  sought  relief  at  this  miraculous  spring, 
and  an  examination  of  their  skeletons  would  have  revealed  curious 
facts  concerning  the  pathology  of  early  Christian  times. 

Among  the  very  few  vertebrae  discovered  at  Abou  Menas  were:  (1)  an 
axis,  with  a  typical  cap  of  new  bone  of  the  odontoid  process,  and  signs  of 
inflammation  on  the  outer  border  of  the  inferior  articulating  surface;  (2)  a 
cervical  vertebra,  probably  the  fifth,  with  its  left  upper  articulating  surface 
greatly  enlarged  and  eburnated,  and  much  osseous  overgrowth  round  its 
inferior  border;  the  right  lower  articulating  surfaces  showed  similar  changes 
(Plate  LI,  Figs.  14  and  15);  (3)  three  dorsal  vertebrae  from  one  grave  with 
marked  thickening  of  the  anterior  borders,  and  inflammation  round  the  costo- 
vertebral articulation;  (4)  four  lumbar  vertebrae  with  great  thickening  and 
formation  of  osteophytes  of  the  anterior  borders;  the  interspinous  ligaments 
had  also  been  affected,  for  the  spinous  processes  were  very  rough. 

It  has  been  shown  that  spondylitis  deformans  existed  in  Nubia 
from  the  earliest  periods  down  to  the  Christian  era,  that  is,  for  a 
period  of  eighty  centuries  at  least.  In  Lower  Egypt,  that  is,  round 
Alexandria,  it  has  been  traced  from  the  time  of  Alexander  down  to 
the  time  of  Abou  Menas,  that  is,  for  another  period  of  eight  hundred 
years.  The  data  regarding  the  incidence  of  this  disease  in  Upper 
Egypt  may  now  be  examined. 

Facts  previously  enumerated  prove  that  the  disease  existed  in 
the  predynastic  period,  at  the  time  of  the  pyramid  builders  and  in 


238         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

the  Illrd  Dynasty,  and,  indeed,  the  case  of  Nefermaat,  a  rich  man 
of  that  dynasty,  is  one  of  the  most  typical  on  record. 

The  lesions  now  to  be  described  were  observed  in  the  skeleton  of 
a  mummy  of  the  Xllth  Dynasty  (2000-1788  B.C.),  given  to  me  by 
the  late  Sir  Gaston  Maspero. 

This  woman  had  died  at  an  advanced  age,  for  the  sutures  of  the  skull, 
with  the  exception  of  the  squamous  suture,  were  ossified.  The  teeth  were 
deeply  worn,  and  the  alveoli  of  the  left  maxillary,  first  premolar,  and  all  three 
left  molars,  and  the  right  second  and  third  molars  were  obliterated.  The  left 
maxillary  canine  was  carious. 

The  first  four  cervical  vertebrae  were  normal;  on  the  fifth  there  was  a 
strong  osteophyte  growing  from  the  anterior-inferior  part  of  the  body.  The 
sixth  cervical  was  normal,  whereas  a  strong  osteophyte  occupied  the  left 
anterior-inferior  border  of  the  seventh. 

The  dorsal  vertebrae  were  healthy,  with  the  exception  of  the  ninth  and 
tenth,  the  adjoining  borders  of  which  were  united  in  the  middle  line  by  a 
thick  osteophyte  about  15  mm.  long  and  3  mm.  broad  at  its  base.  The  second 
and  third  lumbar  vertebrae  showed  some  lipping.  The  spinous  processes  from 
the  tenth  dorsal  to  the  second  lumbar  vertebra  were  joined  together  by  a 
bridge  of  new  bone. 

The  lesions,  therefore,  though  not  severe,  were  typical. 

Skipping  a  period  of  a  thousand  years,  let  us  now  examine  a 
skeleton  from  the  XXnd  Dynasty  (945-743  B.C.)  given  me  by  Pro- 
fessor Flinders  Petrie.  The  vertebral  column  showed  the  following 
changes : 

The  atlas  was  normal  except  that  a  flat  osteophyte,  almost  10  mm.  long, 
surrounded  nearly  half  the  outer  border  of  the  right  upper  articulating  surface. 
Another  small  osteophyte  protruded  from  the  posterior  border  of  the  left 
upper  articulating  surface. 

The  extremity  of  the  left  transverse  process  of  the  atlas  was  much  thick- 
ened, and  was  longer  and  broader  than  its  fellow  of  the  right  side.  The  fora- 
men for  the  left  vertebral  artery  was  not  completely  closed. 

Distinct  rough  new  bone  extended  along  the  inferior-posterior  border  of 
the  body  of  the  fifth  cervical  vertebra,  and  all  round  the  superior  and  inferior 
borders  of  the  body  of  the  sixth.  Each  vertebral  foramen  was  divided  into 
two  unequal  parts  by  a  thin  spiculum  of  bone. 

Seventh  cervical. — New  bone  extended  round  the  upper  border  of  the 
body,  and  was  more  marked  on  the  right  side.  The  foramen  for  the  right 
vertebral  artery  was  narrowed  by  osseous  growth  to  one-fourth  the  size  of  that 
on  the  left  side. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  239 

First  dorsal  (Plate  LI,  Fig.  16). — Rough  new  bone  along  the  superior- 
anterior  border,  extending  for  about  3  mm.  down  the  body  of  the  vertebra. 
The  left  costo-vertebral  articulating  surfaces  of  the  first,  tenth,  and  eleventh 
dorsal  vertebrae  showed  marked  signs  of  inflammation. 

First  lumbar. — Distinct  thinning  of  the  body. 

Second  lumbar. — Distinct  roughening  and  formation  of  osteophytes  on  the 
borders  of  both  superior  and  on  the  right  inferior  articulating  surfaces. 

Third  lumbar. — New  bone  round  the  anterior  part  of  superior  border.  A 
thin  ridge  of  bone  was  prolonged  on  the  left  of  the  middle  line  along  the  anterior 
part  of  the  body  into  a  thick  osseous  excrescence  which  almost  surrounded 
the  lower  border;  this  was  especially  marked  on  the  left  side.  The  right 
superior  articulating  surface  was  very  rough,  and  its  borders  were  surrounded 
by  a  ring  of  new  bone  (Plate  LI,  Fig.  17). 

Fourth  lumbar. — A  very  thick  layer  of  new  bone  extended  round  the 
anterior  border,  especially  on  the  left  side,  and  in  the  middle  for  some  distance 
on  the  body  of  the  vertebra  down  to  the  left  lower  border.  Much  new  bone 
had  formed  at  the  base  and  behind  the  left  superior  and  inferior  articulating 
processes. 

Fifth  lumbar. — New  bone  right  round  superior  border  extending  down- 
wards along  body  nearly  for  10  mm. 

We  now  again  skip  a  period  of  approximately  five  hundred  years, 
and  examine  a  skeleton  dating  from  the  time  of  the  Persian  occupa- 
tion of  Egypt  (about  500  B.C.). 

All  the  vertebrae  were  present,  except  the  axis  and  the  seventh  cervical, 
which  could  not  be  found. 

Atlas. — The  facet  for  the  odontoid  process  was  surrounded  above  and 
laterally  by  a  strong  layer  of  rough  new  bone.  From  the  shape  of  the  facet, 
it  was  evident  that  the  odontoid  process,  instead  of  pointing  directly  upwards, 
was  bent  slightly  backwards.  The  right  tubercle  for  the  attachment  of  the 
transverse  ligament  and  the  bone  just  below  the  right  condylar  process  were 
slightly  roughened.  The  foramen  in  the  right  transverse  process  was  not 
completely  closed. 

Third  cervical  vertebra  (Plate  L,  Fig.  n). — -The  upper  and  lower  sur- 
faces of  the  body  were  deeply  hollowed,  especially  the  former,  the  hollow  of 
which  was  nearly  10  mm.  in  depth.  Its  upper  surface  was  very  rough.  Some 
formation  of  new  bone  along  the  anterior  lower  border,  where  the  new  bone 
was  approximately  2  mm.  thick.  The  whole  body  was  very  thin,  measuring 
about  5  mm.  in  thickness,  and  there  had  been  a  good  deal  of  absorption  of 
bone  on  the  inferior  surface  laterally. 

Fourth  cervical. — This  showed  the  same  lesion,  but  the  osteophyte  along 
the  anterior-inferior  border  was  stronger  and  irregular.  The  body  was  dis- 
tinctly atrophied  and  less  than  5  mm.  thick. 


240         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Fifth  cervical. — Marked  hollowing  of  upper  surface  of  the  body.  Forma- 
tion of  new  bone  along  the  upper  anterior  border,  and,  to  a  less  extent,  along 
the  upper  posterior  borders.  Lower  surface  practically  normal.  Thickness 
of  vertebra =6  mm. 

Sixth  cervical. — No  new  bone;   the  body  about  12  mm.  thick. 

Seventh  cervical. — Missing. 

Sixth  dorsal. — The  left  lower  articulating  surface  very  irregular  in  shape, 
rough,  and  nearly  double  the  size  of  its  fellow,  on  account  of  the  formation  of 
new  bone  around  it. 

Seventh  dorsal. — The  right  upper  and  lower  articulating  surfaces  very 
irregular  in  shape  and  double  the  size  of  their  fellows.  The  bodies  of  both 
these  vertebrae  were  somewhat  thinner  on  the  right  side. 

Eighth  dorsal. — The  left  inferior  articulating  surface  was  greatly  enlarged 
and  very  irregular,  with  some  thick  new  bone  growing  round  it.  The  anterior- 
superior  border  of  the  body  was  somewhat  rough.  The  inferior  border  of  the 
body  was  rough  and  there  was  an  osteophyte  3  mm.  thick  and  about  10  mm. 
long  on  the  right  side.  Both  upper  articulating  surfaces  were  very  irregular 
and  rough,  owing  to  formation  of  new  bone,  especially  on  the  left  side.  Right 
side  of  body  distinctly  atrophied. 

Ninth  dorsal. — Lower  articulating  surface  was  very  rough  and  irregular, 
especially  on  the  left  side.  Upper  articulating  surfaces  fairly  smooth  but 
very  irregular  in  shape.  Upper  border  of  the  body  had  thrown  out  an  osteo- 
phyte (25  mm.  long  and  10  mm.  broad),  which  met  a  similar  osteophyte 
projecting  from  the  vertebra  above.  Distinct  atrophy  of  the  right  side  of  the 
body  of  the  vertebra.  Lower  border  of  body  had  thrown  out  an  osteophyte 
similar  to  that  from  the  upper  border,  the  two  being  joined  by  a  strong  pillar 
of  new  bone.  The  upper  costo-central  facet  was  enlarged,  rough,  surrounded 
by  new  bone  and  so  altered  as  to  be  almost  unrecognisable. 

Tenth  dorsal  (Plate  LI,  Fig.  18). — On  the  right  superior  border,  a  strong 
osteophyte  met  one  descending  from  the  vertebra  above.  Upper  articulating 
surfaces  irregular,  but  almost  normal  otherwise.  Distinct  atrophy  of  right 
side  of  body.  Some  slight  formation  of  new  bone  along  the  right  inferior 
border  of  body. 

Eleventh  and  twelfth. — Practically  normal. 

First  lumbar. — Normal,  except  for  some  slight  thickening  round  the  left 
superior  articulating  surface. 

Fourth  and  fifth  lumbar. — Some  thickening  around  upper  border  of  body. 

The  lesions  in  these  three  skeletons,  though  not  so  marked  as  in 
others  already  described,  are  quite  typical  and  prove  the  existence  of 
spondylitis  in  Egypt  during  the  period  of  roughly  fifteen  hundred 
years,  extending  from  2000  to  500  B.C. 

We  will  now  pass  over  another  thousand  years  and  examine  some 
Coptic  bodies  found  at  Antinoe,  and  dating  from  about  500  a.d. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  241 

In  the  first,  the  spondylitis  was  limited  to  the  first  five  cervical  vertebrae. 
The  atlas  showed  slight  thickening  of  bone  on  the  anterior  side  round  the 
facet  for  the  odontoid  process.  The  axis  was  normal,  except  that  the  tip 
of  the  odontoid  process  was  covered  by  a  cap  of  new  bone  measuring  3  by 
3  mm.  The  upper  articulating  surfaces  of  the  third  cervical  vertebra  were 
enlarged  as  compared  with  the  corresponding  lower  ones,  the  left  upper  surface 
being  only  slightly  enlarged,  whereas  the  right  measured  15  by  13  mm.  Bone 
had  been  deposited  on  the  borders,  and  the  articulating  surface  itself  had  a 
worm-eaten  appearance.  The  right  upper  and  left  lower  articulating  surfaces 
of  the  fourth  cervical  and  the  left  upper  articulating  surface  of  the  fifth  were 
greatly  enlarged  and  honeycombed,  whereas  the  lower  articulating  surface  of 
the  fifth  and  the  vertebral  column  generally  were  normal. 

In  the  next  case,  in  which  arthritic  lesions  in  other  parts  of  the  body  were 
severe,'  the  alterations  in  the  spinal  column  merely  consisted  of  some  lipping 
between  the  adjoining  borders  of  the  second  and  third,  and  between  the  sixth 
and  seventh  cervical  vertebrae,  and  in  the  dorsal  and  lumbar  regions  from  the 
seventh  dorsal  to  the  fourth  lumbar.  The  lesions  were  most  marked  in  the 
dorsal  region  where  the  new  bone  formed  a  thick  irregular  festoon  round 
the  anterior  border.  The  last  lumbar  vertebra,  the  sacrum  and  coccyx  were 
normal.  Another  case  was  that  of  a  very  muscular  man,  whose  ensiform 
cartilage  showed  a  curious  defect  in  ossification  (Plate  LI,  Fig.  19). 

Cervical  vertebrae,  atlas. — Formations  of  new  bone  from  superior  border 
of  anterior  arch,  so  that  the  tip  of  the  odontoid  process  was  overlapped  (Plate 
LI,  Fig.  20)  by  bone  growing  from  the  atlas.  Inferior  articular  facets  of  the 
third  cervical  vertebra  greatly  enlarged  especially  on  the  right  side,  where 
they  were  rough  and  irregular,  with  a  thin  line  of  new  bone  on  the  inner  border. 
The  superior  articular  facets  of  the  fourth  cervical  vertebra  were  correspond- 
ingly enlarged,  especially  the  right  one,  which  measured  20  mm.  from  above 
downwards.  The  third  dorsal  vertebra  had  a  strong  anterior  median  ridge  of 
new  bone  projecting  for  about  12  mm.,  which  fitted  in  with  a  similar  ridge  on 
the  fourth.  Similar  lesions  existed  from  the  sixth  to  the  ninth  dorsal  vertebrae, 
both  inclusive,  and  were  especially  marked  on  the  two  last,  where  these  ridges 
formed  a  lateral  prolongation  10  mm.  broad  at  the  base  and  projecting  exter- 
nally for  12  mm. 

The  lesions  of  osteo-arthritis  in  the  vertebral  column  of  Copts 
were  sometimes  slight,  consisting  merely  of  some  lipping  of  the 
anterior  borders  of  two,  three,  or  more  vertebrae.  The  lesions  in 
one  vertebral  column  were  limited  to  periarticular  inflammation  of 
one  (twelfth)  costo-vertebral  articulation,  which  was  enlarged, 
white,  and  ivory-like.  The  head  of  the  corresponding  rib  was 
enlarged  and  showed  strong  periarticular  exostoses. 

To  sum  up:  spondylitis  deformans  has  existed  in  Nubia  and 
Upper  Egypt  during  the  predynastic  periods,  in  the  early,  old, 


242         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

middle,  and  new  dynastic  and  Ptolemaic  kingdoms,  during  the 
Roman  occupations,  and  later. 

II.      LESIONS   IN   THE   VERTEBRAL   COLUMN 

Osteo-arthritis  of  the  vertebral  column  having  been  proved  to 
exist  in  Egypt  from  the  earliest  times,  the  more  minute  description 
of  the  lesions  in  the  vertebral  column  may  now  be  proceeded  with. 
No  attempt  to  deal  with  the  subject  in  a  chronological  order  will  be 
made,  as  the  facts  just  enumerated  have  shown  that,  in  the  main, 
the  lesions  of  chronic  articular  or  periarticular  disease  present  the 
same  characteristics  in  archaic  Nubians  as  in  predynastic,  dynastic, 
and  Ptolemaic  Egyptians,  the  inhabitants  of  Alexandria  during  the 
Greek  and  Roman  periods,  and  the  Copts  of  early  Christian  times. 
The  pathological  anatomy  of  spondylitis  did  not  vary  during  this 
period  of  eight  thousand  years.  Further,  it  is  clear  that  geographi- 
cal distribution  did  not  influence  the  course  or  incidence  of  the 
disease,  since  specimens  from  Lower  Egypt,  Upper  Egypt,  and 
Nubia  showed  that  the  frequency,  nature,  and  severity  of  the  lesions 
were  unaffected  by  varying  climatic  conditions. 

Probably  the  earliest  and  certainly  the  most  characteristic  lesion 
was  the  growth  of  an  osteophyte  from  the  antero-lateral  borders  of 
the  body  of  one  or  more  vertebrae.  As  a  rule,  three,  four,  five,  or 
more  were  attacked,  although  very  occasionally  the  disease  was 
limited  to  one  or  two  vertebrae.  When  the  disease  had  started 
from  the  borders  of  two  neighbouring  vertebrae,  the  osteophytes 
thrown  out  from  each  ultimately  met,  forming  an  osseous  bridge; 
whereas  the  bases  of  the  osteophytes  on  the  vertebral  borders 
were  from  2  to  3  mm.  broad  and  were  prolonged  for  a  few  milli- 
metres only  on  the  bodies  of  the  vertebrae.  This  intervertebral 
bridge  formed  an  arch,  the  concavity  of  which  was  turned  towards 
the  intervertebral  spaces  (Plate  LI,  Fig.  21).  The  new  bone  was 
rather  soft  and  spongy  and  not  eburnated,  even  when  it  attained 
a  considerable  size.  The  osteophytes  were  usually  situated  uni- 
laterally or  bilaterally,  hardly  ever  centrally;  and  the  posterior 
border  of  the  vertebrae  was  never  attacked  until  the  disease  had 
made  considerable  progress  elsewhere. 

This  manner  of  onset  was  the  rule  for  the  dorsal  and  lumbar,  but 
not  for  the  cervical  vertebrae,  the  periarticular  borders  and  articular 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  243 

surfaces  of  which  were  often  attacked  when  the  bodies  were  still 
normal. 

At  a  later  stage  the  bases  of  the  osteophytes  spread  on  the 
vertebral  bodies  until  those  from  the  superior  and  inferior  borders 
coalesced.  In  bilateral  disease  the  osteophytes  sometimes  extended 
from  each  side  until  they  met  in  or  near  the  middle  line,  so  that  the 
anterior  and  lateral  surfaces  of  the  bodies  were  covered  by  a  thick 
ring  of  bone  (Plate  XLIX,  Fig.  4,  and  Plate  LII,  Fig.  22). 

When  the  posterior  border  of  the  body  was  attacked,  the  layer  of 
new  bone  along  the  vertebral  canal  was  never  more  than  1  or  2  mm. 
thick,  and  therefore  could  not  have  pressed  on  the  spinal  cord  during 
life.  Sometimes  the  layer  thrown  out  from  the  posterior  borders 
coalesced  with  those  coming  from  the  anterior  round  the  vertebrae 
and  intervertebral  spaces.1 

Admitting,  then,  that  the  pathological  process  attacked  the  liga- 
ments chiefly  if  not  solely,  it  is  logical  to  consider  whether  the 
immunity  of  the  central  parts  of  the  bodies  may  not  be  explained  by 
the  anatomical  connections  of  the  vertebral  ligaments.  In  this  con- 
nection it  may  be  remembered  that  the  superficial  fibres  of  the 
anterior  common  ligament  extend  from  one  vertebra  to  the  fourth 
or  fifth  below,  passing  over  the  bodies  of  one  or  two  vertebrae  with- 
out touching  them,  whereas  the  deepest  fibres  are  attached  to 
adjacent  vertebrae ;  and  also,  that  the  fibres  adhere  more  closely  to 
the  intervertebral  discs  than  to  the  bones,  and  are  stretched  across 
the  transverse  depression  over  the  middle  of  the  bodies  without  being 
attached  to  the  latter.  Some  thin  and  scattered  fibres  on  the  sides 
of  the  bodies  reach  from  one  bone  to  the  other.  Lesions  of  the 
anterior  common  ligament  starting  in  the  superficial  fibres  would  be 
most  evident,  firstly,  near  the  upper  and  lower  borders  of  the  verte- 
brae; and,  secondly,  opposite  the  vertebral  discs,  where  the  anterior 
common  ligament  adheres  most  closely  to  the  bodies  of  the  verte- 
brae; that  is,  just  where,  as  a  matter  of  fact,  the  lesions  are 

1  Xote  by  J.  G.  Willmore. — It  has  already  been  pointed  out  that  in  ancient 
Egyptians  as  in  modern  races  the  disease  began  and  spread  in  the  ligaments, 
i.e.,  that  in  its  inception,  at  all  events,  it  was  perivertebral  rather  than  vertebral. 
Analysis  of  the  specimens  already  described  affords,  I  think,  sufficient  ground  for  this 
contention,  since  it  was  invariably  the  ligaments,  and  more  especially  the  anterior 
common  ligament,  which  were  the  first  to  be  attacked  and  showed  the  most  advanced 
pathological  changes. 


244         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

most  marked.  During  life,  or  before  putrefaction  has  proceeded 
far,  slight  lesions  of  the  anterior  common  ligaments  would  probably 
have  been  discovered  opposite  the  bodies  of  the  vertebrae;  but  in 
the  graves,  these  small  and  delicate  osteophytes,  not  being  in  close 
contact  with  the  vertebrae,  doubtless  fell  to  pieces  and  were  lost. 
In  severe  cases,  on  the  other  hand,  the  lesions  still  subsisted  thou- 
sands of  years  after  death. 

The  fact  that  the  disease  generally  started  from  the  anterior 
border  laterally,  and  not  centrally,  may  perhaps  be  explained  by  the 
very  close  adherence  of  the  ligamentous  fibres  to  the  lateral  verte- 
bral borders;  whereas  the  slightness  of  the  lesions  near  the  trans- 
verse process  was  perhaps  due  to  the  thinness  and  scarcity  of  the 
ligamentous  fibres  in  that  neighbourhood. 

The  intervertebral  discs,  which,  though  shrunken,  were  found  in 
mummified  or  dried  bodies  with  severe  spondylitis,  were  apparently 
normal,  and  as  a  rule  the  intervertebral  spaces  were  not  altered  in  size 
or  in  shape.  For  example,  a  vertebral  column  from  a  "pan  grave" 
at  Ballalish,  dating  from  the  Xllth  to  XVIth  Dynasties,  showed  very 
severe  lesions  of  spondylitis  (Plate  LII,  Fig.  23),  and  yet  the  inter- 
vertebral discs,  though  shrivelled  from  desiccation,  were  not  other- 
wise altered.  When  moistened,  the  discs  were  easily  split  up  into 
two  thick  laminae,  enclosing  a  smooth-walled  cavity,  and  there  was 
no  trace  of  new  bone. 

The  laminae  of  a  normal  disc,  which  are  arranged  concentrically, 
consist  mainly  of  parallel  fibrous  bundles,  running  obliquely  between 
the  vertebrae  and  attached  firmly  to  both.  The  outermost  layer  is 
made  up  of  ordinary  fibrous  tissue,  the  deeper  and  more  numerous 
laminae  of  cartilage,  and  the  central  part  of  a  pulpy  and  elastic, 
material.  A  thin  cartilaginous  layer  on  the  lower  and  upper  sur- 
faces of  each  vertebra  gives  attachment  to  the  discs,  which  are 
thickest  in  the  lumbar  region,  thinnest  in  the  intervals  from  the 
third  to  the  seventh  dorsal  vertebrae,  and  form  together  about  one- 
fourth  of  the  length  of  the  movable  part  of  the  column.  The  curva- 
ture of  the  cervical  and  lumbar  portions  of  the  vertebral  column  is 
due  principally  to  the  form  of  the  discs,  which  are  much  thicker  in 
front  than  behind. 

In  cases  of  spondylitis  among  ancient  Egyptians  no  part  of  the 
discs  was  ossified,  except  the  ring  of  fibrous  tissue  and  cartilage  in 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  245 

contact  with  the  borders  of  the  vertebrae.  Nevertheless,  some  of  the 
intervertebral  discs  were  occasionally  absorbed,  with  the  result  that 
the  vertebrae  fell  together;  and,  owing  to  the  anatomical  peculiari-. 
ties  noted  above,  the  removal  by  disease  of  the  cervical  and  lumbar 
discs  caused  very  severe  deformities,  such  as  the  falling  forward  of 
the  head  on  the  chest  (Plate  XLIX,  Fig.  3). 

The  articulations  of  the  vertebrae  were  characteristically 
affected.  Each  articulation  presents  a  synovial  cavity  surrounded 
by  a  fibrous  capsule  composed  of  ligaments,  which  are  longer  and 
looser  in  the  cervical  than  in  the  dorsal  and  lumbar  regions. 

The  periarticular  borders  of  these  articulations  were  often  studded 
with  large  osteophytes  which  developed  in  the  fibrous  capsule.  They 
doubtless  caused  great  inconvenience,  for  the  extent  of  the  move- 
ments of  the  vertebral  column,  other  than  extension  and  flexion,  are 
determined  chiefly  by  the  position  of  the  articular  surfaces.  In 
the  dorsal  region  these  allow  a  certain  degree  of  rotation;  in  the 
lumbar  region  lateral  flexion  but  not  rotation  is  possible,  although 
by  combining  this  lateral  with  antero-posterior  flexion  some  degree 
of  circumduction  is  produced.  Severe  lesions  of  the  articular  sur- 
faces in  several  regions  of  the  vertebral  column,  therefore,  immobil- 
ised the  whole  of  the  spine,  and,  when  limited  to  the  cervical  column, 
they  prevented  all  movements  of  the  head  and  neck,  even  when  the 
other  parts  of  the  vertebrae  remained  healthy.  New  osseous  tissue 
might  surround  the  joint,  and  yet  the  articulating  surfaces  often 
remained  untouched  by  disease,  except  in  the  instance  which  will 
be  described  further  on. 

The  articulating  surfaces  of  the  atlas  with  the  skull  were  gener- 
ally normal,  even  in  the  rare  cases  when  the  borders  of  the  condyles 
were  distorted  by  periarticular  inflammation,  so  that  ankylosis  of  the 
head  with  the  atlas  was  rare.  In  six  thousand  bodies  examined  in 
Nubia,1  only  one  case  of  ankylosisof  the  occipito-atlantal  articulation 
due  to  spondylitis  was  discovered. 

In  this  case  complete  fusion  existed  between  the  right  occipital  condyle 

and  the  corresponding  articular  surface  of  the  atlas,  and  the  left  atlantal  facet 

was  fused  partly  to  the  condyle,  and  partly  to  the  lower  surface  of  the  jugular 

of  the  OCi  ipital  lone.     The  skull  in  this  last  case  was  firmly  ossified 

with  the  upper  cervical  vertebra,  and  the  resulting  deformity  was  very  great. 

1  Wood  Jones,  Archaeological  Survey  of  Nubia,  iejoy-8,  II,  244. 


246         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  spinal  canal  formed  an  obtuse  angle  with  the  foramen  magnum,  and  the 
man's  chin  must  have  almost  touched  his  chest.  On  the  other  hand,  the 
articular  surfaces  between  the  atlas  and  axis  were  often  enlarged,  irregular, 
eburnated,  and  immobilised  by  a  powerful  ring  of  new  bone.  The  surfaces  for 
the  insertion  of  the  occipito-atloid  ligaments  often  showed  inflammatory- 
changes. 

Very  peculiar  were  the  alterations  in  the  articulating  surfaces  of  the 
odontoid  process  and  of  the  atlas.  The  articulating  surface  of  the  process,  and 
the  facet  for  the  latter  on  the  arch  of  the  atlas  were  eburnated  and  their  borders 
rough,  ragged,  and  irregular;  the  rounded  tubercle  for  the  attachment  of  the 
transverse  ligament  was  similarly  altered. 

A  very  striking  product  of  chronic  inflammation  was  the  little  cap 
of  osseous  tissue  frequently  crowning  the  tip  of  the  odontoid  process. 
This  little  bony  prominence,  resembling  a  Phrygian  cap  (Plate  LII, 
Fig.  24)  nicely  balanced  on  the  tip  of  the  process,  was  doubtless  what 
remained  of  the  attachments  of  the  bands  of  the  more  or  less  ossified 
ligaments  which  united  the  process  firmly  with  the  neighbouring  parts 
and  certainly  interfered  considerably  with  movement.  The  atlanto- 
axial articulation  allows  the  movements  of  rotation  of  the  head 
and  of  the  atlas  on  the  axis,  with  the  odontoid  process  as  a  pivot,  the 
movements  being  checked  by  ligaments ;  while  the  occipito-atlantal 
articulation  allows  only  very  slight  rotation  but  considerable  flex- 
ion and  extension  of  the  head  upon  the  vertebral  column.  As  the 
axi-atlantal  articulations  were  frequently  attacked  while  the  atlanto- 
occipital  articulations  usually  escaped,  rotation  of  the  head  was  often 
abolished  when  nodding  movements  remained  free. 

A  further  impediment  to  the  lateral  movements  and  rotation  of 
the  head  was  the  ossification  of  the  transverse  and  cruciform  liga- 
ments at  their  points  of  attachment,  and  especially  the  very  severe 
lesions  of  the  articulation  between  the  odontoid  process  and  atlas. 
The  movements  of  the  head  were  hindered  most  by  the  pathological 
changes  in  the  odontoid  process;  and  the  small  cap  of  new  bone, 
often  crowning  this  process,  at  the  point  of  attachment  of  the  ante- 
rior and  posterior  occipito-axial,  occipito-atlantal,  and  atlan to-axial 
ligaments,  bears  witness  to  the  gravity  of  the  pathological  alterations 
in  these  important  structures.  The  movements  of  flexion  and 
extension  of  the  head,  therefore,  were  sometimes  interfered  with, 
but  rotation  was  probably  more  often  and  more  completely  abolished 
when  the  atlanto-axial  articulation  was  ankylosed. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  247 

The  periarticular  and  articular  changes  also  interfered  with  free- 
dom of  movement,  for  even  in  unilateral  disease  the  neck  was 
immobilised  and  the  patients  assumed  the  curious  bird-like  attitude 
of  sufferers  from  cervical  spondylitis  deformans. 

When  the  anterior  part  of  the  vertebral  bodies  and  the  trans- 
verse processes  were  involved,  the  action  of  the  muscles,  such  as  the 
longus  colli,  attached  to  the  bodies  and  transverse  processes  of  the 
cervical  vertebrae,  was  certainly  interfered  with. 

The  bodies  of  the  cervical  vertebrae  often  appeared  to  be  atro- 
phied— an  illusion  caused  by  the  growth  of  strong  osteophytes  on  the 
anterior  and  posterior  borders,  which  made  the  concavity  and  the 
upper  surface  appear  deeper  and  the  bodies  thinner  than  they  really 
were.  One  peculiarity  of  the  disease  in  that  region  was  that  it  was 
sometimes  limited  to  one  or  two  articulations  on  one  side. 

The  shrinking  of  the  intervertebral  cartilages,  accompanying  or 
resulting  from  these  lesions,  inevitably  produced  several  deformities. 
In  the  first  place,  the  patient's  height  was  diminished.  In  the 
second  place,  owing  to  the  greater  thickness  of  the  anterior  part  of 
the  normal  cartilage,  shortening  was  more  marked  anteriorly,  and 
the  head  easily  followed  its  natural  tendency  to  fall  forward  on  the 
chest,  the  patient  then  assuming  the  attitude  usually  supposed  to 
be  typical  of  old  age. 

The  lesions  of  the  cervical  vertebrae,  even  when  limited  to  the 
neighbourhood  of  the  articulating  surfaces,  were  almost  always 
extremely  severe.  From  being  roughly  oval,  the  articulating  sur- 
faces became  irregular  in  shape,  often  enormously  enlarged  and, 
owing  to  the  formation  of  new  bone,  almost  convex,  with  a  "worm- 
eaten"  appearance  due  to  enlargement  of  the  blood  vessels.  Ebur- 
nation  of  these  surfaces  was  more  common  than  in  any  other  region, 
and  the  fibrous  capsule  was  often  converted  into  a  ring  of  dense  new 
bone,  which  effectually  put  a  stop  to  all  movements.  All  these 
lesions  finally  converted  all  the  structures  composing  this  part  of  the 
cervical  column  into  a  rigid  block,  obliterated  the  normal  curvature 
of  the  cervical  spine,  and  thus  led  to  great  deformity  of  that  region. 

The  spinous  processes  of  the  cervical  and  dorsal  regions,  rough 
in  some  cases,  were  usually  normal.  The  supraspinous  ligament 
between  two  or  three  lumbar  vertebrae  was  often  ossified,  and 
occasionally  this  alteration  extended  to  all  the  lumbar  vertebrae ; 


248         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

on  the  other  hand,  the  ligamenta  subflava,  composed  of  yellow  elastic 
tissue,  always  remained  free.  The  muscles  lying  in  the  vertebral 
groove  suffered  severely;  an  imposing  mass  of  new  bone  sometimes 
filled  up  the  whole  groove,  and  firmly  bound  together  the  smaller 
muscles  and  the  tendons  of  the  muscular  masses  attached  to  the 
vertebrae. 

The  disease  in  the  dorsal  region  was  often  limited  to  the  bodies  of 
the  vertebrae,  the  osteophytes  on  the  posterior  and  anterior  borders 
being  sometimes  almost  as  thick  as  the  antero-posterior  diameter  of 
the  vertebral  bodies  themselves  (Plate  XLIX,  Fig.  7). 

The  costo-central  and  costo-transverse  articulating  surfaces  were 
often  normal,  even  when,  as  often  was  the  case,  their  borders  were 
disfigured  as  the  result  of  intense  inflammation  followed  by  deposit 
of  new  bone. 

In  other  cases  these  articulations  were  the  site  of  lesions  which 
are  of  special  interest  in  view  of  their  severity. 

In  some  specimens  the  morbid  process,  proceeding  as  far  as 
marked  eburnation,  extended  to  the  articulating  surfaces;  but 
these  articular  lesions  were  always  accompanied  by  very  marked 
periarticular  changes  and  appeared  to  be  secondary  to  them. 

The  costo-central  articulation  unites  the  heads  of  the  majority  of 
the  ribs  with  two  vertebral  bodies  in  two  distinct  synovial  joints, 
supported  by  ligaments  which  complete  the  capsule  of  the  joint.  An 
interarticular  ligament  divides  the  articulation  into  two  parts,  each 
lined  by  a  separate  synovial  membrane.  The  costo-transverse 
articulation  unites  the  tubercle  and  neck  of  the  rib  to  the  corre- 
sponding transverse  process  in  an  arthrodial  joint;  the  neck  of  each 
rib  is  also  united  by  a  powerful  ligament  to  the  transverse  process  of 
the  vertebra  above.  The  articulation  of  the  ribs  to  the  spinal 
column  behind  and  to  the  sternum  in  front  allows  a  double  move- 
ment of  these  bones,1  but  every  such  movement  produces  some 
friction  in  the  costo-central  and  costo-transverse  articulations.  On 
the  other  hand,  the  muscles  which  elevate  the  ribs  in  respiration 
(external  intercostals,  scalenus  anticus,  serratus  posticus  superior, 
and  the  levatores  costarum)  were  apparently  not  often  involved. 
The  lesions  in  the  tendons  of  the  diaphragm  will  be  discussed  with 
those  of  the  lumbar  region. 

1  Schafer,  A  Text-Book  of  Physiology,  p.  275. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  249 

The  lesions  of  the  articular  surfaces  and  periarticular  borders, 
though  more  common,  were  hardly  ever  as  severe  as  in  other  parts  of 
the  spine.  The  movements  of  the  dorsal  vertebrae  being  limited  in 
extent,  profound  changes  in  the  anterior  and  posterior  ligaments  did 
not  necessarily  interfere  with  the  movements  or  posture  of  the  body, 
and  the  health  of  the  patient  suffered  only  from  difficulties  in 
respiration  due  to  the  involvement  of  the  costo-vertebral  articu- 
lations. 

Pathological  lesions  of  the  intervertebral  discs  of  the  dorsal 
region  were  absent  even  in  cases  otherwise  severe. 

The  lumbar  region  was  most  often  and  most  characteristically 
attacked.  Complete  ossification  of  the  anterior  and  posterior  com- 
mon ligaments  was  not  rare,  resulting  in  the  lumbar  vertebral 
column  being  converted  into  an  immovable  mass.  Further,  in 
severe  cases,  the  upper  and  lower  articulating  surfaces  were  sur- 
rounded by  mushroom-like,  bony  excrescences;  the  transverse 
processes  were  covered  with  flat  stalactites  of  osseous  tissue  (Plate 
LII,  Fig.  25),  the  vertebral  grooves  were  filled  with  masses  of  spongy 
bone  enclosing  all  the  muscular  attachments  in  that  region,  and  the 
spinous  processes  were  rough  and  firmly  held  together  by  the  com- 
pletely ossified  supraspinous  ligament.  The  intervertebral  discs 
alone  usually  escaped. 

As  flexion  and  extension  in  the  lumbar  spine  are  comparatively 
important  movements,  and  as  ossification  of  the  anterior  and 
posterior  ligaments  was  often  extensive  just  in  that  part,  the 
movements  of  the  whole  body  were  considerably  interfered  with; 
the  ossification  of  the  supraspinous  ligament  alone  was  sufficient 
to  prevent  any  approximation  or  separation  of  the  spines  of 
the  vertebrae,  that  is,  all  movements  of  extension  or  flexion. 
Lateral  flexion  also  was  rendered  difficult,  nay  impossible,  by  peri- 
articular inflammation  and  secondary  changes  in  the  articulating 
surfaces. 

Very  far-reaching  in  their  effects  were  the  pathological  changes 
in  the  tendons  of  the  muscles  attached  to  the  lumbar  spine.  The 
diaphragm,  the  most  important  of  these  muscles,  on  account  of  the 
pari  it  plays  in  respiration,  is  attached  to  the  spine  by  its  crura  or 
pillar-,  which  lie  on  both  sides  of  the  aorta  on  the  bodies  of  the  lum- 
bar vertebrae.     These,  at  their  origin,  arc  tendinous  in  structure: 


250         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

the  right  crus,  larger  and  longer  than  the  left,  arising  from  the 
anterior  surface  of  the  bodies  and  intervertebral  substances  of  the 
three  and  four  upper  lumbar  vertebrae;  the  left  from  the  two  upper, 
both  blending  with  the  anterior  common  ligament  of  the  spine.1  As 
it  was  precisely  the  anterior  ligament  that  was  most  often  ossified, 
the  crura  of  the  diaphragm  were  necessarily  involved  in  many  cases, 
and  difficulty  in  respiration,  with  all  its  attendant  evils,  was  the 
result. 

The  pathological  alterations  in  the  many  muscles  attached  to  the 
lumbar  vertebrae  were  of  the  greatest  importance.  The  bending  of 
the  thigh  on  the  body,  and  of  the  body  on  the  thigh,  all  very  impor- 
tant movements,  were  rendered  difficult  by  the  lesions  in  the  attach- 
ments of  the  psoas  to  the  transverse  processes  of  the  bodies  and  to 
the  intervertebral  discs  of  the  lumbar  vertebrae. 

The  erector  spinae,  a  large  muscular  mass,  was  not  infrequently 
involved,  and  in  some  cases  all  the  attachments  of  this  muscle  were 
ossified,  so  that  it  was  practically  put  out  of  action.  Similarly,  the 
disease  involved  the  multifidus  spinae,  which  occupies  the  vertebral 
groove  by  the  side  of  the  row  of  spinous  processes  from  the  sacrum  to 
the  axis,  and  which  is  attached  also  to  the  spinous  processes  of  several 
vertebrae.  The  smaller  rotatores  dorsi,  interspinalis  and  intertrans- 
versalis  muscle.s  often  shared  the  same  fate. 

The  muscles  of  the  back  come  into  play  simultaneously  in  exten- 
sion of  the  head  and,  on  one  side  only,  in  lateral  flexion  of  the 
column.  The  oblique  muscles  rotate  the  head  and  spinal  column, 
and  when  the  spine  is  fixed,  some  of  the  erector  muscles  may 
depress  the  angles  of  the  ribs,  and  thus  assist  in  forced  expiration. 
Ossification  of  the  attachments  of  these  muscles  interfered  to 
some  extent  with  all  these  movements.  The  capsular  ligaments 
not  infrequently  showed  lesions  severe  enough  to  immobilise  the 
lumbar  spine. 

The  lesions  of  the  anterior  parts  of  the  bodies  of  the  vertebrae 
often  extended  so  far  down  the  spine  that  a  strong  osseous  bridge 
joined  the  anterior-inferior  border  of  the  fifth  lumbar  with  the 
anterior-superior  border  of  the  first  sacral  vertebra.  Complete  ossi- 
fication of  the  sacro-lumbar  and  ilio-lumbar  ligaments  was  not  rare, 

1  Gray,  Anatomy. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  251 

and  must  often  have  interfered  with  movement,  even  when  the  sacro- 
iliac articulation  was  normal. 

III.       LESIONS    OF    THE    PELVIS    AND    LOWER    LIMB 

Each  of  the  two  surfaces  entering  into  the  formation  of  the  sacro- 
iliac articulation  is  covered  with  a  layer  of  cartilage;  these  layers, 
though  closely  applied  to  one  another,  are  not  united  except  by  fine 
transverse  fibres  in  front.  Occasionally,  especially  in  elderly  people, 
the  rough  and  irregular  articulating  surfaces  are  separated  by  small 
spaces  containing  glairy  fluid  (Plate  LII,  Fig.  26).  The  sacrum  and 
iliac  bone  are  held  together  by  the  anterior  and  posterior  sacro-iliac 
ligaments,  and  the  articulation  is  further  strengthened  by  the  great 
and  small  sacro-sciatic  ligaments. 

As  a  rule,  these  articulating  surfaces  in  ancient  Egyptians  were 
smooth  and  regular  even  in  the  skeletons  of  people  who  died  at  an 
advanced  age.  The  majority  of  skeletons  with  spondylitis  defor- 
mans had  sacro-iliac  articulating  surfaces  unworn  by  friction  and 
with  no  traces  of  eburnation;  this  immunity  is,  doubtless,  due  to  the 
absence  of  wear  and  tear  in  this  articulation,  for  not  only  does  very 
little  movement  take  place  between  the  bones,  but  almost  the  entire 
weight  of  the  body  rests  on  the  posterior  sacro-iliac  ligament,  from 
which  the  sacrum  is  in  great  part  suspended,  so  to  speak.  The 
rough  space  above  the  auricular  surface  of  the  ilium,  and  the  depres- 
sions on  the  back  of  the  lateral  mass  of  the  sacrum  to  which  the 
posterior  sacro-iliac  ligament  is  attached,  were  often  distinctly  rough 
in  cases  of  spondylitis  deformans,  whereas  the  surfaces  of  attach- 
ment for  the  anterior  sacro-iliac  ligaments  were  usually  nor- 
mal. The  surfaces  for  the  attachment  of  the  great  sacro-sciatic 
ligament  on  the  posterior-inferior  iliac  spine  and  the  side  of  the 
sacrum  and  coccyx  were  generally  quite  normal,  while  the  inner 
margin  of  the  ischial  tuberosity,  the  margin  of  the  ischial  ramus,  and 
the  obturator  fascia  often  showed  very  marked  pathological  changes. 
The  strain  due  to  the  weight  of  the  body  being  borne,  chiefly,  by  the 
sacro-iliac  ligaments,  the  loss  of  power  consequent  on  the  involve- 
ment of  these  structures  certainly  affected  the  carriage  of  the  trunk, 
in  the  standing  position. 


252  STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Two  cases  of  severe  disease  of  the  left  sacro-iliac  articulations 
were  observed.  The  first  was  discovered  in  a  mummy  of  the  XXIst 
Dynasty,  and  has  been  partly  described  by  Elliot  Smith,  who  wrote 
as  follows: 

In  the  case  of  an  extremely  emaciated  old  woman,  called  Nesi-Tet-Nab- 
Taris,  a  curious  state  of  affairs  was  revealed.  Large,  open  ante-mortem  wounds, 
possibly  bedsores,  were  found  on  the  back,  between  the  shoulders,  and  on  each 
buttock.  These  had  been  made  use  of  for  the  purpose  of  packing  the  back,  and 
two  square  sheets  of  fine  leather  (gazelle  skin  ?)  had  been  applied  to  cover  the 
upper  wound  and  the  whole  buttock  respectively. 

These  sheets  had  been  sewn  to  the  healthy  skin  beyond  the  sores  and 
the  edges  hidden  by  strips  of  linen,  which  were  smeared  with  a  resinous  paste. 
A  large  opening,  probably  an  abscess  or  sinus,  extended  transversely  from  the 
left  pudendal  labium  outward  into  the  buttock;  this  had  been  sewn  up  with 
string. 

A  long  ulcer  on  the  back  of  the  leg  had  been  covered  up  by  a  sheet  of 
linen  soaked  in  a  solution  of  resin. 

Evidently  this  old  woman  had  been  long  bedridden.  Professor 
Elliot  Smith  obligingly  gave  me  the  pelvis  and  lower  limbs,  in  the 
hope  that  histological  investigation  might  throw  light  on  the  nature 
of  the  chronic  disease  from  which  she  had  suffered.  The  histological 
examination  threw  no  light  on  the  etiology  of  these  sinuses,  though 
we  discovered  that  the  peroneal  arteries  were  completely  calcified. 

The  remains  of  the  pelvis  and  the  lower  limbs  having  been 
macerated,  the  following  pathological  alterations  were  discovered: 

Right  femur  (Plate  LII,  Fig.  27). — Thick  deposit  of  new  bone  round 
head  of  femur.  Surface  of  great  trochanter  very  rough,  owing  to  deposits  of 
whitish,  spongy-looking  bone,  specially  thick  at  upper  extremity  of  diagonal 
line.  Depression  for  the  ligamentum  teres  irregular,  and  deeply  pitted  at 
bottom. 

Left  femur  (Plate  LII,  Fig.  27). — Neck  about  1  cm.  shorter  than  that  of 
right  femur,  owing  to  absorption;  this  process  having  taken  place  more  rapidly 
at  the  back,  the  neck  had  partly  collapsed  and  the  head  of  the  bone  looked 
almost  directly  backwards.  All  round  the  head,  especially  anteriorly,  new 
bone  had  been  deposited.  Great  trochanter  roughened  by  deposit  of  new 
spongy  bone,  thickest  superiorly  and  anteriorly.  Fossa  for  the  ligamentum 
teres  deeply  pitted  and  much  enlarged. 

Pelvis. — Complete  ankylosis  between  sacrum  and  right  os  innominatum. 
In  right  acetabulum,  separation  between  articular  and  non-articular  parts  was 
almost  obliterated  by  friction.  The  term  ankylosis  is  badly  chosen,  for  it 
cannot  be  shown  that  the  sacro-iliac  articulation  was  attacked  at  all,  it  being 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  253 

entirely  surrounded  by  new  bone.  The  two  bones  were  bound  together  firmly 
by  the  completely  ossified  anterior  and  posterior  sacro-iliac  ligaments. 

On  the  left  side,  no  trace  of  inflammation,  except  on  the  ischial  tuberosity, 
which  was  rougher  than  usual.  In  the  acetabulum  a  layer  of  new  bone  existed 
at  the  junction  of  the  articular  and  non-articular  parts.  The  latter  had  been 
so  much  worn  away  by  friction  that  it  was  of  transparent  thickness. 

The  bones  of  the  leg  were  normal. 

The  second  specimen  showed,  among  other  points  of  interest,  the 
iliac  bones  firmly  ankylosed  to  the  sacrum. 

The  anterior  sacro-iliac  ligament  was  completely  ossified  as  far  as  the 
lower  border  of  the  first  sacral  vertebra,  and  posteriorly  the  bones  were  united 
by  two  strong  bridges  of  osseous  tissue,  separated  by  a  small  interval.  The 
articulation  appeared  to  be  normal.  The  whole  length  of  the  external  surface 
of  the  ischial  ramus,  especially  near  the  inferior  border,  was  covered  with 
thick,  rough,  new  bone,  thinner,  though  still  very  noticeable,  near  the  ramus 
of  the  pubis — the  margins  of  the  obturator  foramen,  the  superior  ramus  of 
the  pubis,  and  ilio-pectineal  eminence  were  roughened  by  stalactites  of  inflam- 
matory osseous  tissue.  The  process,  therefore,  had  attacked  the  sacro-iliac 
ligament  and  all  the  tendons  at  their  points  of  attachment  with  the  ischium 
and  pubis. 

The  stalactite  formations  round  the  left  obturator  foramen  were  even  more 
marked.  The  non-articular  portion  of  the  right  acetabulum  was  normal, 
whereas  a  strong  ridge  of  new  bone,  thickest  on  the  outer  side,  lined  the  upper 
border  of  the  articular  portion. 

The  right  ischial  tuberosity,  especially  its  external  and  inferior  border, 
showed  signs  of  very  severe  chronic  inflammation,  and  the  left  acetabular 
cavity  was  much  worn,  without  any  formation  of  new  bone. 

It  remains  doubtful  whether  the  sacro-iliac  articulation  was  involved,  in 
spite  of  the  almost  complete  ossification  of  the  anterior  and  posterior  sacro- 
iliac ligaments,  owing  to  the  fact  that  here,  as  elsewhere,  the  disease  was 
periarticular  and  not  articular. 

The  pubic  articulation,  which  is  hardly  movable  in  the  normal, 
non-pregnant  person,  occasionally  showed  changes  which  may  have 
been  caused  by  osteo-arthritis.  A  curious  lesion  found  in  one  Cop- 
tic body  may  be  described  here,  although  its  etiology  is  uncertain. 

The  external  surface  of  the  right  ramus  of  the  pubis  and  part  of  the  body 
were  covered  with  a  layer  of  new  bone,  which  was  smooth  for  the  most  part, 
except  where  it  had  a  worm-eaten  appearance.  This  plate  of  bone  measured 
40  by  45  mm.,  and  was  about  7.5  mm.  thick  in  some  places;  it  was  sharply 
limited  superiorly  by  a  ridge  and  a  deep  groove,  and  there  had  evidently 
been  some  periostitis  along  the  lower  border  of  the  ramus  of  the  pubis,  as  far 
as  its  junction  with  the  ramus  of  the  ischium. 


254         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  articulating  surfaces  of  the  symphysis  pubis  were  smooth  and 
appeared  healthy,  and  on  each  side  of  the  joint  on  the  internal  surface  there 
was  a  layer  of  new  spongy  bone,  5  mm.  broad,  and  about  2.5  mm.  thick  on 
the  right,  and  1  mm.  thick  on  the  left  side.  The  left  innominate  bone  was 
otherwise  healthy,  and  there  was  no  trace  of  any  suppuration  round  the  pubis. 
An  interesting  point  was  that  on  both  dorsal  and  lumbar  vertebrae  there 
was  a  small  amount  of  lipping  due  to  deposit  of  new  bone  along  the  upper 
and  lower  anterior  borders  of  the  bodies.  The  intervertebral  discs  and  the 
ligaments  were  not  ossified. 

It  is  certain  that,  possibly  owing  to  the  lesions  described,  this 
person  had  long  been  bedridden,  as  a  huge  bedsore  occupied  the 
lumbar  region,  in  which  numerous  micro-organisms  were  seen  with 
the  microscope. 

Far  more  important  than  the  changes  in  the  sacro-iliac  and  pubic 
articulations  were  those  on  the  points  of  attachment  of  the  muscles 
arising  from  the  iliac  bones  and  pelvis.  In  a  skeleton  from  Kom  el 
Shougafa,  for  instance,  the  rami  of  the  ischium  and  pubis,  the 
tuberosities  of  the  ischium,  and  especially  the  spaces  between  the 
inferior  curved  line  and  the  upper  border  of  the  acetabulum  were 
covered  with  small,  round,  osseous  elevations  (Plate  LII,  Fig.  28). 
Very  often,  the  crest  of  the  ilium  was  disfigured  from  end  to  end  by 
jagged  new  bone,  which  testified  to  previous  severe,  chronic  inflam- 
mation. Of  course,  this  crest  is  always  rugged,  but  in  these  cases 
important  bone  stalactites  sprang  from  the  internal  and  external  lips 
and  from  the  intermediate  ridge.  The  attachment  of  the  gluteus 
maximus  was  thus  involved  in  the  disease,  and  therefore  extension, 
abduction,  and  rotation  of  the  limb,  the  maintaining  of  the  erect 
position  and  the  regaining  of  it  after  stooping,  were  probably  ren- 
dered difficult;  let  it  be  noted  that  the  last  is  the  most  painful 
and  difficult  movement  for  sufferers  from  "muscular  rheumatism" 
of  the  back.  The  attachments  of  the  latissimus  dorsi  were  also 
attacked,  and  as  this  muscle  plays  an  important  part  in  inspiration, 
walking,  climbing,  and  in  movements  of  the  arms,  the  lesions  of  its 
attachments  to  the  pelvic  brim  helped  to  make  all  these  movements 
difficult  and  painful.  Similarly,  the  disease  involved  the  attach- 
ments of  the  abdominal  obliquus  externus  and  internus,  which  keep 
the  abdominal  cavity  tense  and  act  as  expiratory  muscles  when  the 
vertebral  column  is  fixed ;  thus  the  changes  seen  at  their  attachments 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  255 

perhaps  rendered  the  bending  and  the  rotation  of  the  thorax  some- 
what distressing,  as  is  sometimes  the  case  now  in  patients  with 
chronic  muscular  rheumatism.  Lesions  of  the  tendon  of  the  gluteus 
medius,  where  this  muscle  is  attached  to  the  pelvis,  must  have 
interfered  with  the  abduction  of  the  thigh  and  the  maintenance  of 
the  erect  position  of  the  body. 

From  the  posterior  part  of  the  iliac  crest  arise  the  quadratus 
lumborum  and  erector  spinae,  and  the  pathological  changes  in  the 
attachments  of  these  muscles  must  have  caused  the  maintenance  of 
the  spine  in  the  erect  posture  and  the  bending  of  the  trunk  back- 
wards to  be  painful  and  distressing. 

Very  important  were  the  lesions  of  the  surfaces  for  the  attach- 
ments of  the  tendon  of  the  rectus  femoris  muscle  on  the  anterior- 
inferior  iliac  spine,  and  of  its  reflected  tendon  just  above  the 
acetabulum  (Plate  LOT,  Fig.  29).  Both  places  were  sometimes 
covered  with  small  mammillated  exostoses,  developed  partly  in  the 
periosteum,  and  doubtless  in  the  tendinous  muscular  attachments  as 
well.  As  this  muscle,  together  with  the  psoas  and  iliacus,  supports 
the  pelvis  and  trunk  upon  the  femur,  or  bends  them  forwards,  lesions 
in  this  situation  checked  the  maintenance  of  the  erect  attitude  of  the 
trunk,  and  probably  also  impaired  the  other  actions  of  this  muscle. 

Disease  of  the  rami  of  the  pubis  and  ischium  might  involve  the 
tendinous  attachments  of  the  obturator  externus,  adductor  gracilis, 
and  quadriceps  in  front;  of  the  obturatur  internus,  levator  pro- 
statae,  transversus  perinei,  erector  penis,  and  compressor  urethrae 
behind;  of  the  pectineus,  rectus  abdominis,  and  pyramidalis  near 
the  angle  of  the  pubis,  and  of  the  levator  ani  on  the  posterior  sur- 
face. All  the  movements  of  the  thigh,  therefore,  and  especially 
progression,  were  to  some  extent  checked  by  disease  in  that  region, 
for  many  of  these  muscles  assist  in  drawing  the  limb  forward. 
Similarly,  the  maintenance  of  the  body  in  an  erect  posture,  flexion 
of  the  pelvis  forwards  upon  the  femur,  movements  of  the  thigh  on 
the  pelvis,  of  the  pelvis  on  the  thigh,  of  the  leg  on  the  thigh,  and 
vice  versa,  were  obstructed  by  the  lesions  described  above. 

The  attachments  of  the  hamstring  muscles,  semi-membranosus, 
semi-tendinosus,  biceps,  gemelli,  coccygeus,  and  levator  ani  to  the 
ischial  tuberosity  and  its  neighbourhood  often  suffered  severely;  in 


256         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

consequence,  flexion  of  the  knee,  rotation  of  the  tibia  outwards  by 
the  biceps,  semi-tendinosus  and  semi-membranosus,  together  with 
extension  of  the  hip,  were  impeded,  and  doubtless  occasioned  great 
distress  to  the  patient.  The  lesions  of  the  attachments  of  the  gemelli 
interfered  with  the  support  of  the  hip-joint  posteriorly  and  with 
rotation  and  abduction  of  the  limb.  Forcible  expiratory  and  other 
expulsive  efforts  were  checked  by  the  changes  in  the  coccygeus, 
levator  ani,  and  other  muscles  of  the  perineum ;  the  lack  of  support 
to  the  pelvis  must  have  caused  unpleasant  symptoms,  such  as 
difficult  evacuation  of  the  rectum. 

In  such  cases,  therefore,  the  movements  of  the  back,  lower  and 
upper  limbs,  micturition,  and  defaecation  were  embarrassed  and 
rendered  painful  by  the  implication  of  the  attachments  of  the  upper 
extremities  of  voluntary  muscles;  and  it  will  be  obvious  presently 
that  matters  were  often  rendered  worse  by  the  implication  of  many 
of  the  inferior  attachments  of  these  same  muscles. 

The  lesions  of  the  hip-joint  were  perhaps  the  most  important 
of  all,  because,  even  when  slight,  they  interfered  more  than  any 
other  lesions  with  the  maintainance  of  the  erect  posture  and  pro- 
gression forwards  or  backwards. 

The  cotyloid  ligament,  a  thick  nbro-cartilaginous  ring  round  the 
margin  of  the  acetabulum,  which,  as  the  transverse  ligament,  bridges 
over  the  gap  of  the  acetabular  border,  suffered  less  than  one  would 
have  expected.  Even  with  severe  lesions  of  other  parts  of  the 
articulation,  the  margin  and  immediate  neighbourhood  of  the  acetab- 
ulum were  often  smooth  and  to  all  appearance  healthy.  Some- 
times, however,  the  margin  of  the  acetabulum  was  topped  by  a  ring 
of  new  bone,  so  fragile  as  to  be  usually  more  or  less  broken  by  post- 
mortem injuries ;  but  occasionally  this  hyperostosis  was  sufficient  to 
increase  the  depth  of  the  joint  (Plate  LIII,  Fig.  30).  In  cases  still 
more  severe,  the  inflammatory  area  extended  to  neighbouring 
parts — even,  as  we  have  seen,  to  the  attachment  of  the  reflected 
tendon  of  the  rectus. 

The  transverse  ligament  was  never  completely  ossified,  though 
severe  changes  at  its  attachments  were  often  recognisable;  the 
osseous  borders  which  the  ligament  unites  often  displayed  distinct 
post-inflammatory  hyperostosis,  and  it  was  unfortunate  that  the 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  257 

ligaments  themselves  had  been  destroyed  by  post-mortem  changes. 
One  important  lesion  Was  represented  by  a  festoon  of  new  bone 
formed  by  the  thickening  of  the  lower  border  of  the  articular  portion 
of  the  joint,  most  marked  at  the  point  of  attachment  of  the  ligamen- 
tum  teres  (Plate  LIII,  Fig.  29).  Further,  while  the  pit  for  the  liga- 
mentum  teres,  on  the  head  of  the  femur  is  normally  a  small,  smooth, 
round  depression,  in  femora  with  lesions  of  chronic  osteo-arthritis 
this  pit  was  more  or  less  completely  obliterated  by  new  bone,  which, 
like  melted  wax  (Plate  LIII,  Fig.  31),  had  filled  it  and  then  flowed 
over  the  neighbouring  surfaces.  The  lesions  at  both  ends  of  the 
ligament  indicate  that  most  probably  the  whole  was  ossified,  and  as 
flexion,  abduction,  or  rotation  of  the  hip  must  necessarily  stretch 
this  ligament,  these  movements  must  have  been  greatly  impeded. 
A  more  advanced  lesion  was  the  gradual  wearing  down  of  the 
lower  brim  of  the  articular  portion  of  the  acetabulum,  until  at  one 
particular  point  the  division  between  the  articular  and  non-articular 
portions  was  obliterated.  This  point  was  almost  opposite  to  the 
transverse  ligament,  but  slightly  posterior  to  it  (Plate  LIII,  Fig.  32). 
The  top  of  the  .head  of  the  femur  was  always  normal  except  for  the 
changes  in  the  fossa  for  the  ligamentum  teres.  Eburnation  was 
never  seen.1 

1  Note  by  J.  G.  Willmore. — In  the  late  Sir  Armand  Ruffer's  manuscript  we  found 
at  this  point  a  note  to  this  effect:  "Put  here  paragraph  on  Coxa  Vara." 

The  limited  time  at  my  disposal  unfortunately  precluded  us  from  making  anything 
like  a  complete  examination  of  the  mass  of  material  upon  which  Sir  Armand  based  the 
conclusions  given  in  this  paper;  but,  as  far  as  I  have  been  able  to  determine,  his  results 
would  seem  to  agree  with  the  findings  of  Wood  Jones,  who  stated  (Archaeological 
Survey  of  Nubia,  Bull.  No.  2  [Cairo,  1908],  p.  57)  that  many  examples  of  coxa  vara 
were  found  by  him  among  skeletons  exhumed  from  the  cemeteries  at  Shellal,  above  the 
First  Cataract. 

Wood  Jones  drew  attention  to  the  absence  of  any  of  the  cardinal  signs  of  the  bony 
manifestations  of  rickets  in  any  single  instance,  out  of  the  large  number  of  skeletons  of 
young  people,  of  all  ages  up  to  puberty,  which  he  had  examined;  at  the  same  time 
later  bone  changes,  in  which  it  has  been  customary  to  invoke  rickets  as  the  causative 
factor,  were  by  no  means  uncommon.  He  therefore  suggested  that  the  origin  of  these 
later  bony  changes  lies  in  some  factor  other  than  rickets. 

Sir  Armand  appears  to  have  arrived  at  the  same  conclusion:  an  idea  which  is 
strengthened  by  the  fact  that  the  femora  which  I  have  been  able  to  examine  show 
merely  shortening  of  their  necks  due  to  atrophy  and  absorption  of  the  bone,  without 
any  of  th<  deformity  due  to  bending  and  twisting  of  the  bone  which  is  typical  of  coxa 
vara  of  definite  rachitic  origin  (Plate  LIII,  Fig.  33). 


258         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  lesions  in  the  attachments  of  certain  parts  of  the  capsule 
were  serious,  especially  those  already  described  at  the  point  of  origin 
of  the  upper  extremity  of  the  ilio-femoral  ligament,  on  the  lower 
anterior  spinous  process.  The  maintenance  of  the  erect  position 
puts  a  strain  on  the  ilio-femoral  ligament,  and  inflammatory  lesions 
at  the  point  where  it  is  attached  to  the  anterior  intertrochanteric 
line  were  among  the  most  common  lesions.  The  whole  length  of 
this  bony  ridge  was  in  some  cases  studded  with  small  rough  exos- 
toses, and  the  lesions  of  this  important  ligament,  by  impeding  the 
extension  of  the  joint,  produced  a  certain  amount  of  pain  and  made 
the  standing  position  almost  impossible  (Plate  L,  Fig.  10). 

The  upper  attachments  of  the  femoral  ligament  band  opposite 
the  outer  head  of  the  rectus,  and  the  lower  attachment  to  the  upper 
and  fore  part  of  the  great  trochanter  and  neck  of  the  femur  often 
exhibited  similar  changes,  which  during  life  doubtless  impeded  move- 
ment, more  especially  adduction  of  the  hip-joint.  Whereas  the 
upper  attachment  of  the  pubo-femoral  band  was  generally  intact, 
the  lower  end  connected  with  the  neck  of  the  femur,  level  with 
and  in  front  of  the  small  trochanter,  was  frequently  the  seat  of 
osteophytes  which  interfered  with  movement  of  the  hip-joint,  par- 
ticularly with  abduction  of  the  limb. 

Perhaps  the  most  important  lesion  of  the  capsule  was  that  affect- 
ing the  bands  of  transverse  fibres,  which  is  about  as  wide  as  the 
middle  finger,  and  arches  like  a  collar  round  the  neck  of  the  bone. 
At  this  point,  just  below  the  neck  of  the  femur,  there  was  often  a 
pad  of  bone,  generally  about  30  mm.  long,  1 5  mm.  wide,  and  per- 
haps 2  mm.  thick,  which  represented  this  ossified  ligament;  and 
it  was  clear  that  the  longitudinal  as  well  as  the  transverse  fibres  of 
the  capsule  had  been  involved  in  the  pathological  processes. 

To  sum  up :  The  pathological  changes  in  the  hip-joint  were  most 
obvious  where  the  ligaments  were  attached,  whereas  evidently  the 
acetabular  cartilage  was  involved  later.  The  head  of  the  femur, 
where  it  was  covered  by  cartilage,  was  never  the  seat  of  disease, 
except  at  its  periphery  and  at  the  point  of  insertion  of  the  ligamen- 
tum  teres. 

The  extra-articular  changes  in  the  superior  extremity  of  the 
femur  come  next  in  order.     The  surfaces  of  the  great  torchanter 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  259 

were  often  the  seat  of  severe  lesions.  The  whole  trochanter,  for 
instance,  might  be  covered  with  rough  new  bone  without  any 
recognisable  hgaments  or  tendinous  framework;  on  the  other  hand, 
the  structure  of  the  tendons  inserted  in  that  situation  was  in  some 
cases  still  so  plainly  visible  that  occasionally  the  whole,  but  more 
often  only  the  anterior  surface  of  the  great  trochanter,  looked  as  if 
delicate  tendinous  fibres  had  been  frozen  on  to  it.  The  muscular 
attachments  involved  were  those  of  the  gluteus  medius  on  the 
external  surface,  gemelli,  pyriformis,  obturator  internus,  and,  above 
all,  the  tendon  of  the  obturator  externus  in  the  digital  fossa,  which 
cavity  was  often  filled  with  remnants  of  the  ossified  tendons  of  this 
last  muscle.  All  these  lesions  certainly  did  not  conduce  to  freedom 
of  movement. 

The  upper  part  of  the  anterior  intertrochanteric  line  to  which 
the  capsular  ligament  of  the  hip-joint  is  attached,  and  the  lower 
part  from  which  some  of  the  fibres  of  the  vastus  internus  originate, 
were  often  extensively  altered.  The  posterior  intertrochanteric 
line  suffered  less  than  the  anterior,  and  indeed  was  rarely  the  seat 
of  pathological  changes;  the  small  trochanter  often  escaped  more 
or  less  completely. 

The  anterior  part  of  the  shaft  below  the  anterior  intertrochan- 
teric line,  and  the  lateral  parts  as  far  as  the  proximity  of  the  knee- 
joint,  were  practically  always  normal,  and  they  contrasted  therefore 
with  both  extremities  of  the  bone. 

The  two  lines  of  attachment  for  the  gluteus  maximus,  pectineus, 
and  iliacus  were  often  roughened  by  many  thick,  bony  outgrowths 
which  might  extend  to  half  the  length  of  the  shaft.  This  condition 
was  not  due  to  abnormal  muscular  development,  as  it  was  seen  in 
femurs  in  which  the  other  muscular  attachments  were,  if  anything, 
rather  slighter  than  the  average,  but  which  showed  distinct  osteo- 
arthritic  changes  at  their  extremities. 

A  peculiar  deformity  of  the  femur  is  shown  in  Plate  LIII,  Fig.  34.  Here 
the  great  trochanter  and  the  intertrochanteric  line  are  capped  by  an  enormous 
growth  of  spongy  bone  measuring  about  5  cm.  in  thickness,  which  is  reflected 
in  a  thick  layer  round  the  junction  of  the  neck  of  the  bone  with  the  shaft. 
The  neck  of  the  bone  itself  is  practically  normal.  This  enormous  growth 
consists  of  loose,  spongy  bone,  which,  microscopically,  shows  nothing  peculiar. 


260         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  lower  extremity  of  the  femur  presents  some  slight  signs  of  osteo-arthritis 
round  the  borders.     The  shaft  of  the  femur  is  nowhere  enlarged. 

The  diagnosis  in  this  case  must  remain  doubtful.  I  thought  at  first  that 
the  specimen  was  one  of  osteoma  or  osteosarcoma.  Against  this  diagnosis  it 
may  be  pointed  out  that  the  shaft  of  the  femur  itself  appears  to  be  quite 
normal,  and  the  surface  of  the  tumour,  except  over  the  great  trochanter,  is 
everywhere  quite  smooth.  The  interior  of  the  growth  is  composed  of  normal, 
loose,  osseous  tissue. 

Considering  that  this  person  had  slight  osteo-arthritic  lesions  of  the  lower 
extremity  and  of  the  head  of  the  bone,  it  may  be  argued  that  the  more  striking 
lesions  were  also  of  the  same  nature.  Assuming  this  to  be  possible,  it  is  not  a 
little  strange  that  the  lesions  should  be  almost  entirely  limited  to  the  part 
round  the  trochanters.  Unfortunately,  the  other  bones  belonging  to  this 
skeleton  could,  not  be  discovered,  this  lying  loose  in  the  ossarium. 

Another  interesting  femur  found  in  the  same  ossarium  showed  the  head 
almost  completely  worn  away,  though  signs  of  inflammation  could  still  be  seen 
along  its  upper  and  outer  borders  (Plate  LIII,  Fig.  35).  The  great  trochanter 
had  been  badly  smashed.  In  this  instance,  I  do  not  think  the  possibility  of 
the  lesions  having  been  tubercular  can  be  excluded.  Similar  changes  also 
existed  all  along  the  bony  ridge  to  which  the  two  vasti  and  the  three  adductor 
muscles  were  attached.  It  has  been  shown  already  that  the  upper  attach- 
ments of  these  muscles  to  the  os  pubis  were  often  the  seat  of  pathological 
lesions,  so  that  both  ends  of  the  muscles  were  involved;  consequently,  as  one 
or  more  of  these  muscles  take  part  in  almost  every  movement  of  the  lower 
limbs,  walking,  running,  jumping,  getting  up  from  the  kneeling  or  recumbent 
position,  and  other  movements  must  have  been  greatly  impeded. 

The  knee-joint  was  perhaps  the  articulation  most  frequently 
attacked  by  chronic  osteo-arthritis,  possibly  on  account  of  its  size, 
of  the  number  of  ligaments  entering  into  its  composition,  and  of  the 
fact  that,  more  than  any  other  large  joint  of  the  body,  it  is  liable  to 
traumatisms  of  all  kinds.1 

The  part  of  the  anterior  lateral  ligament  passing  over  and  inti- 
mately incorporated  with  the  patella  was  very  often  the  seat  of 
chronic  inflammation,  which  hardened  in  pathological  ossification. 
The  upper  surface  of  the  patella  was  then  striated  longitudinally, 
and  the  raised  borders  of  these  striae  were  prolonged  into  thin  osteo- 
phytes, which  in  well-preserved  specimens  overhung  the  borders  of 
the  bones  for  a  few  millimetres.     Lower  down,  where  the  anterior 

1  Note  by  J.  G.  Willjiore. — Another  possible  factor  is  that  the  knee-joints 
combine  great  mobility  with  the  support  of  the  weight  of  the  trunk — compare  the 
frequency  with  which  gout  attacks  the  joint  of  the  great  toe  in  modern  people. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  261 

ligament  and  the  lateral  patellar  ligament  are  connected  with 
each  side  of  the  tubercle  of  the  tibia,  pathological  changes  were 
uncommon. 

On  the  back  of  the  outer  condyle  of  the  femur,  a  mass  of  new 
bone  often  indicated  the  point  of  insertion  of  the  posterior  liga- 
ment, and,  similarly,  the  point  of  insertion  of  the  ligament  on  the 
tendon  of  the  semi-membranosus  muscle  was  indicated  in  the  same 
manner. 

The  lower  end  of  the  femur  in  many  cases  was  disfigured  by  a 
thick  rim  of  new  bone  which  closely  followed  the  borders  of  both 
condyles  and  greatly  resembled  the  narrow  brim  of  an  old-fashioned 
billycock  hat  (Plate  L,  Fig.  8) .  The  superior-anterior  border  of  the 
external  condyle  was  often  prolonged  upwards  into  a  thick  spur,  an 
osteophyte  which  sometimes  was  nearly  5  mm.  long,  and  which 
stood  out  prominently  from  the  neighbouring  tissues  below.  The 
borders  of  the  intercondylar  notch  at  the  back  of  the  joint  did  not 
escape,  though  the  rim  of  new  bone  there  was  less  thick  and  promi- 
nent than  on  the  lateral  or  anterior  edges  of  the  articulation.  In 
such  cases,  the  attachments  of  the  capsular  ligament  being  ossified 
from  end  to  end,  the  great  part  of  the  ligament  was  very  probably 
ossified  during  life,  and  produced  great  difficulty  in  the  movements 
of  the  knee-joint  or  even  immobilised  it.  The  imposing  thickness 
of  newly  formed  bone  was  proof  of  the  chronic  character  of  the 
disease,  which  doubtless  had  lasted  for  many  years  before  death. 

At  the  back  of  the  external  condyle  of  the  femur,  a  thick  patch  of 
new  bone  sometimes  marked  the  attachment  of  the  anterior  or 
external  crucial  ligament;  a  similar  new  formation  in  the  depression 
in  front  of  the  spine  of  the  tibia  corresponded  to  the  inferior  attach- 
ment of  this  ligament;  a  tag  of  new  bone,  sometimes  15  mm.  long, 
remained  as  evidence  of  the  partial  or  complete  ossification  of  this 
ligament.  Similarly,  the  hinder  part  of  the  depression  behind  the 
spine  of  the  tibia,  the  popliteal  notch,  and  the  inner  condyle  of  the 
femur  often  presented  the  lesions  typical  of  chronic  periarticular 
disease,  and  there  was  no  doubt  that  both  crucial  ligaments  had  been 
partly  or  wholly  ossified.  The  ligaments  of  the  knee,  therefore,  had 
undergone  the  same  changes  as  those  of  the  hip;  and  as  most  if  not 
all  of  the  joints  had  been  attacked  in  some  patients,  the  articular 


262         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

surfaces  remaining  normal,  it  follows  that  impairment  of  motion  in, 
or  even  complete  immobility  of,  the  articulation  sometimes  resulted 
from  periarticular  lesions  alone.  The  surfaces  of  attachment  for  the 
articular  cartilages  of  the  tibia  were  sometimes  distorted  by  osseous 
proliferation,  but  as  these  lesions  were  seen  only  in  those  cases  in 
which  the  periarticular  alterations  were  intense,  without  any  ossifica- 
tion of  the  cartilages,  it  follows  that  in  all  probability  the  disease-did 
not  attack  the  cartilages  till  very  late.  Sometimes  an  ivory-white, 
eburnated  patch  on  one  or  both  articulating  surfaces  of  the  tibia  had 
resulted,  and  the  eburnated  surface  was  usually  striated  longitudi- 
nally, elongated  from  before  backwards,  and  measured  from  20  to 
35  mm.  in  its  longest,  and  about  15  to  20  mm.  in  its  shortest  trans- 
verse diameter.  In  the  large  majority  of  skeletons  no  new  bone 
had  been  deposited  on  these  surfaces  of  the  femur  or  patella,  which 
are  normally  protected  by  cartilages;  the  latter  had  been  worn 
through  the  eburnation  of  the  bone  as  a  consequence  (Plate  LIII, 

Fig.  35).  _ 

Occasionally,  the  inflammation  of  the  bony  articulating  surface 
led  to  its  disfigurement  by  small  round  or  oval  patches  of  raised 
bone,  studded  with  numerous  small  holes,  the  sites  of  enlarged  blood 
vessels,  which  were  not  infrequently  surrrounded  by  eburnated 
borders.  These  were  evidently  the  vestiges  of  inflammatory 
reaction  following  on  the  wearing  through  of  the  cartilage.  These 
patches,  fairly  common  on  the  femur,  were  rare  on  the  tibia. 

The  very  important  changes  on  the  head  of  the  tibia  were  similar 
to  those  on  the  femur.  Contrary  to  expectation,  the  attachment  of 
the  ligamentum  patellae  was  normal,  even  when  periarticular  lesions 
of  the  knee-joint  were  conspicuous;  whereas  the  anterior  parts  of 
the  internal  and  external  tuberosities  often  suffered  severely,  frag- 
ments of  the  ossified  ligaments,  as  much  as  10  mm.  long,  sometimes 
remaining  as  evidence  of  the  severity  of  the  morbid  process  in  the 
past.  The  surface  of  attachment  for  the  semi-membranosus  was 
often  thickened  by  new  bone,  and  as  we  have  seen  that  in  some 
cases  the  upper  attachments  of  the  muscles  had  been  attacked  also, 
the  work  of  this  muscle  must  have  been  impeded  considerably;  on 
the  other  hand,  the  attachments  of  the  lower  ends  of  the  sartorius, 
semi-tendinosus,  and  gracilis  were  usually  healthy. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  263 

The  spine  of  the  tibia,  close  to  which  the  extremities  of  the  semi- 
lunar cartilages  are  attached,  and  the  rough  depression  behind  it  for 
the  attachments  of  the  anterior  and  posterior  crucial  ligaments,  were 
often  the  seat  of  obvious  lesions  (Plate  LIV,  Fig.  37). 

Very  marked  also  were  the  changes  in  the  neighbourhood  of  the 
tibio-fibular  articulation.  The  borders  of  joints  otherwise  normal 
were  rugged  and  thickened  by  new  bone,  and  sometimes  it  was  clear 
that  a  complete  osseous  capsule  had  surrounded  the  joint.  The 
external  surface  of  the  styloid  process  of  the  fibula  was  usually  most 
affected,  and  was  covered  with  delicate,  bony  stalactites,  as  if  fibres 
of  the  anterior-superior  or  posterior-superior  ligaments  had  been 
frozen  on  to  the  process. 

The  crest,  the  internal  cutaneous  surface,  the  tibial  attachments 
for  the  tibialis  anticus  and  tibialis  posticus  were  practically  always 
normal.  The  inferior  extremity  of  the  tibia  was  but  seldom  seriously 
altered  by  lesions.  The  articular  surface  with  the  astragalus  was 
always  normal,  the  periarticular  changes  were  never  more  than  slight. 

This  immunity,  however,  did  not  extend  to  the  lower  tibio- 
fibular articulation,  the  borders  of  which  were  altered  like  those  of 
the  hip  or  knee-joint.  A  triangular  patch  of  rough  bone,  with  its 
base  at  the  inferior  extremity,  often  extended  up  the  tibia  for  2  or  3 
inches,  and  opposite  to  it  there  was  a  similar  patch  on  the  fibula. 
The  surfaces  of  attachment  for  the  ligaments  were  frequently  rough 
and  aberrant  in  shape. 

The  oblique  line  to  which  the  soleus  is  attached  was  the  only  part 
of  the  shaft  of  the  tibia  ever  involved.  It  was  often  considerably 
thickened  and  protruded  for  3  or  4  mm.  with  an  external  edge  as 
much  as  2  or  3  mm.  broad. 

The  four  borders  of  the  fibula  were  often  extremely  rough  and 
uneven,  whereas  the  surfaces  of  attachment  for  the  muscles  of  the  big 
toe  and  foot  remained  smooth.  It  would  seem,  therefore,  that  the 
aponeuroses  suffered,  while  the  muscles  escaped  (Plate  LIV,  Fig.  38). 

IV.      LESIONS  OF    THE    STERNUM,  CLAVICLE,  RIBS,   AND    UPPER   LIMB 

The  sterno-clavicular  articulation  is  formed  by  the  sternal  end  of 
the  clavicle,  the  upper  and  lateral  part  of  the  manubrium  sterni,  and 
the  cartilage  of  the  first  rib,  and  allows  limited  movements  in  almost 


264         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

every  direction — upwards,  downwards,  backwards,  and  forwards,  as 
well  as  circumduction;  the  clavicle  in  its  motion  carries  with  it  the 
scapula.  The  importance  of  this  joint  is  great  because  it  is  the  only 
point  of  articulation  of  the  supporting  arch  of  the  shoulder  with  the 
trunk.1  The  result  of  these  connections  is  that  almost  every  move- 
ment of  the  shoulder  produces  a  corresponding  movement  in  the 
sterno-clavicular  articulation,  and,  therefore,  pressure  on  the  inter- 
articular  fibro-cartilage.  Elevation  of  the  clavicle  is  principally 
limited  by  the  costo-clavicular,  depression  by  the  interclavicular, 
ligament.  The  movements  of  the  costo-clavicular  part  of  the 
articulation  are  markedly  increased  in  dyspnoea,  and  are  limited 
by  the  anterior  and  posterior  sterno-clavicular,  the  interarticular 
and  costo-clavicular  ligaments. 

Complete  ossification  of  adjoining  surfaces  was  never  found. 
The  articulating  surface  of  the  clavicle  was  often  greatly  worn,  and 
sometimes  almost  eburnated. 

The  attachments  of  the  stemo-cleido-mastoid,  pectoralis  major 
and  subclavius  muscles,  closely  connected  with  the  articulation  in 
front,  and  the  attachments  of  the  sterno-hyoid  and  sterno-thyroid 
behind,  were  always  normal.  The  interclavicular  ligament  also 
escaped  as  a  rule,  although  the  impression  for  the  rhomboid  liga- 
ment was  often  altered  by  chronic  inflammation. 

The  borders  of  the  small,  flattened,  oval  facet  of  the  acromial  end 
of  the  clavicle  were  usually  normal,  while  the  articulating  surface  on 
the  acromion  and  its  periarticular  borders  and  the  attachment  of 
the  conoid  and  trapezoid  ligaments  were  often  thickened  by  bony 
deposits  (Plate  LIV,  Fig.  39).  In  many  instances  the  articulating 
surfaces  looked  as  if  they  had  been  worm-eaten  and  were  distinctly 
eburnated.  Though  the  movements  of  the  acromio-clavicular 
articulation  were  perhaps  never  entirely  prevented  by  neighbouring 
lesions,  it  is  certain  that  any  pressure  on  this  articulation,  such  as 
that  produced  by  movements,  must  have  caused  intense  pain. 

The  lesions  of  the  costo-central  and  costo-transverse  articulations 
have  been  already  described.  The  only  other  frequent  change  in 
the  rib  was  extreme  roughening  of  the  interior  border  near  the 
angle,  for  about  3  inches  in  front  and  behind,  but  that  this  attrition 
was  due  to  arthritis  was  not  established. 

1  Gray,  Anatomy. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  265 

It  is  strange  that  when  most  articulations,  and  especially  the 
large  articulations  of  the  lower  limbs,  were  attacked,  the  shoulder- 
joint  in  the  large  majority  of  Egyptian  cases  should  have  remained 
immune.  Here  the  articular  ligaments  do  not  limit  to  the  same 
extent  the  degree  of  movement  by  maintaining  the  articular  sur- 
faces in  such  close  apposition  as  they  do  in  the  hip ;  and  the  looseness 
of  the  articulation  may  have  been  the  cause  of  this  comparative 
immunity.1 

The  lesions  of  the  glenoid  ligament,  the  nbro-cartilaginous  rim 
attached  to  the  margin  of  the  glenoid  cavity,  consisted  in  the  forma- 
tion of  a  periarticular  ring,  and  considering  the  close  connection  of 
the  tendon  of  the  biceps  with  this  ligament,  these  lesions  must  have 
interfered  with  the  action  of  the  muscle. 

The  attachment  of  the  capsular  ligament  to  the  scapula  was 
seldom  if  ever  attacked,  whereas  the  anatomical  neck  was  often 
surrounded  by  a  slightly  raised  border  of  smooth  new  bone,  never 
projecting  for  more  than  about  1  mm.  nor  exceeding  3  mm.  in 
breadth.  This  new  border  was  never  disfigured  by  projecting 
osteophytes,  and  gave  the  impression  of  having  been  the  result  of  a 
very  mild  chronic  process. 

Occasionally,  the  acromion  process  and  the  portion  of  the  scapu- 
lar spine  from  which  the  deltoid  arises  were  much  deformed  by  the 
comparatively  large  masses  of  bone  deposited  on  them.  The  action 
of  the  deltoid,  one  of  the  most  powerful  muscles  of  the  arm,  was 
therefore  interfered  with. 

The  lesions  of  the  humerus  were  most  marked  at  the  points  of 
insertion  of  muscles  closely  connected  with  the  shoulder-joint.  New 
bone  was  deposited  on  the  greater  tuberosity  to  which  the  supra- 
spinatus,  infraspinatus,  and  teres  minor  are  attached,  on  the  lesser 
tuberosity,  at  the  point  of  insertion  of  the  subscapularis,  and  on  the 
anterior  and  posterior  bicipital  ridges  of  the  bicipital  groove,  where 
the  pectoralis  major,  teres  major,  and  latissimus  dorsi  are  inserted 
(Plate  LIV,  Fig.  40) .  In  many  cases,  therefore,  although  the  articu- 
lating surfaces  were  perhaps  intact,  the  movements  of  the  arm  and 
shoulder-joint  may  have  been  rendered  painful,  or  may  have  become 
impeded,  or  even  totally  arrested,  by  lesions  of  ligaments  and  of 
tendons  passing  over  the  joint.     The  lesions  in  the  shaft  of  the 

'  Note  by  J.  G.  Willmore. — Further,  the  shoulder-joint  has  no  weight  to  support. 


266         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

humerus  were  limited,  as  a  rule,  to  the  bicipital  groove  and  neigh- 
bouring parts.  So  in  the  humerus,  as  in  the  femur,  tibia,  and  fibula, 
it  is  evident  that  the  disease  attacked  the  neighbourhood  of  the 
articulation,  and  the  shaft  of  the  bone  escaped  almost  completely. 

The  changes  in  the  shoulder-joint,  therefore,  were  identical  with 
those  of  all  the  joints  studied  so  far,  namely,  apparent  immunity  of 
the  articulating  surfaces  and  involvement  of  the  neighbouring 
attachments  of  ligaments  and  muscles. 

The  observations  just  related  were  made  on  skeletons  from 
Upper  and  Lower  Egypt.  In  Nubia,1  on  the  other  hand,  the  disease 
was  by  no  means  uncommon  in  the  shoulder-joint,  and  here  the 
deformity  produced  in  the  head  of  the  humerus  was  often  con- 
spicuous. Hard,  bony  masses  developed  round  the  margins  of  the 
articular  surface  of  the  head  of  the  bone,  the  articular  surface  itself 
became  frequently  displaced,  and  a  considerable  impairment  of 
movement  must  have  been  the  result  of  this  deformity  of  the  bone. 

The  lesions  of  the  two  articulations  of  the  elbow  may  be 
described  together. 

In  front,  the  upper  and  lateral  borders  of  the  coronoid  depression 
were  often  covered  by  a  ring  of  dense,  almost  eburnated,  new  bone, 
and  the  coronoid  depression  itself  sometimes  contained  a  mass  of 
dense,  often  typically  eburnated,  new  bone,  which  almost  filled  it. 
The  same  alterations  existed  in  and  around  the  radial  depression, 
which  was  sometimes  almost  completely  obliterated. 

The  internal  borders  of  the  trochlea  and  the  articulation  for  the 
head  of  the  radius  were  often  lined  with  a  thick  border  of  new 
bone  forming  a  ring  round  the  articular  surfaces,  which,  though  less 
massive  than  that  round  the  knee-joint,  nevertheless  must  have 
caused  considerable  inconvenience  (Plate  LIV,  Fig.  41).  The 
olecranon  depression  was  often  disfigured  by  osteophytes,  thickest 
at  the  apex  of  the  triangle  formed  by  that  cavity,  that  is,  on  a  level 
with  the  posterior  ligament.  Eburnation  of  the  trochlear  surface 
was  rarely  very  marked,  and  the  eburnated  surface  was  streaked 
with  parallel  longitudinal  lines  resulting  from  the  grinding  of  the 
articulating  surfaces  on  one  another. 

The  changes  in  the  ulna  were  peculiar.  The  inner  and  outer 
borders  of  the  lesser  sigmoid  cavity  and  of  the  coronoid  process  were 

2  Wood  Jones,  Archaeological  Survey  of  Nubia,  1907-S,  II,  275. 


PLATE  XLIX 


PLATE  L 


PLATE  LI 


PLATE  LII 


PLATE  LIII 


PLATE   LIV 


42. 


ARTHRITIS  DEFORMANS  AND  SPONDYLITIS  267 

often  greatly  thickened ;  on  the  other  hand,  the  articulating  surface 
of  the  greater  sigmoid  cavity  almost  always  escaped  and  eburnation 
was  rare. 

The  subcutaneous  part  of  the  posterior  surface  of  the  olecranon, 
covered  by  a  bursa,  was  always  'normal,  while  the  top  of  the  olecra- 
non was  often  capped  by  a  thick  layer  of  new  bone,  sometimes  as 
much  as  5  mm.  thick,  which  had  formed  in  the  posterior  articular 
ligament  and  in  the  tendon  of  the  triceps.  The  attachment  of  the 
anconeus  generally  escaped,  whereas  that  of  the  coronoid  head  of 
the  flexor  sublimis  digitorum  was  often  rough. 

The  border  of  the  coronoid  process  of  the  sigmoid  cavity  did  not 
escape,  and  the  lesions  were  most  marked  on  the  triangular  surface 
below  it,  that  is,  at  the  point  of  attachment  of  the  brachialis  anticus 
(Plate  LIV,  Fig.  42).  In  Nubian1  skeletons,  the  roughening  and 
deformity  of  the  joint  outweighed  the  process  of  eburnation,  so 
commonly  seen  in  typical  modern  examples  of  arthritis  deformans. 

The  head  of  the  radius  escaped,  except  in  a  few  cases  in  which 
eburnation  was  present,  though  but  little  bone  was  worn  away. 
Sometimes  the  head  was  capped  by  new  bone  which  was  prolonged 
into  a  point  at  the  ulna  articulation. 

Eburnation  of  the  lesser  sigmoid  cavity  was  very  rare,  even 
though  the  borders  of  the  cavity  were  surrounded  by  a  delicate 
rim  of  smooth  new  bone,  possibly  an  ossified  orbicular  ligament. 

The  upper  part  of  the  shaft  of  the  radius  was  practically  always 
normal  except  for  hypertrophy  and  roughness  of  the  bicipital  tuber- 
osity, which  in  many  cases  were  doubtless  due  to  powerful  muscular 
development;  when  the  remainder  of  the  skeleton  did  not  point  to 
the  presence  of  mighty  muscles,  this  condition  was  probably  patho- 
logical. The  attachments  of  the  interosseous  membrane  between 
the  radius  and  ulna  were  always  normal. 

The  pivot  formed  by  the  head  of  the  ulna  and  the  lower  end  of 
the  radius  was  always  healthy,  except  for  some  occasional  slight 
thickening  round  the  articular  surfaces. 

The  surfaces  of  attachment  for  the  anterior  and  posterior  radio- 
ulnar ligaments  also  escaped  as  a  rule. 

' "/  he  Description  of  Plata  X I.IX-LIV  will  be  found  in  the  text) 


STUDY   OF   ABNORMALITIES   AND   PATHOLOGY  OF 
ANCIENT  EGYPTIAN  TEETH 

{American  Journal  of  Physical  Anthropology, 
Vol.  Ill  [July,  1920],  No.  3) 

PREFATORY  NOTE 

My  husband  intended  to  publish  almost  simultaneously  with  this  paper  on 
Ancient  Egyptian  Teeth,  another  on  Arthritis  and  Spondylitis,  considering  dental 
disease  an  important  etiological  factor  in  the  causation  of  arthritis. 

Owing  to  his  untimely  death,  he  left  the  latter  work  incomplete,  and  I  have 
been  unable  to  supply  many  missing  links  between  the  two  papers,  as  I  cannot  prove 
to  my  satisfaction  that  certain  diseased  teeth,  mandibles,  etc.,  belong  to  the  same 
skeletons  which  show  marked  arthritic  lesions  of  various  joints.  However,  with 
the  kind  assistance  of  Captain  Willmore,  R.A.M.C.,  I  have  finished  the  paper  on 
arthritis  to  the  best  of  my  ability,  and  it  has  appeared  in  the  Journal  of  Pathology. 

A  third  paper  was  begun  in  connection  with  the  present  one,  for  on  remarking 
the  effect  of  the  food  of  the  people  in  producing  attrition,  caries,  etc.,  Sir  Armand 
made  a  study  of  the  food  of  the  ancient  Egyptians. 

These  with  three  other  papers  which  I  shall  endeavor  to  finish  for  him,  and 
fourteen  which  he  had  already  published,  were  destined  to  form  parts  of  a  book  he 
intended  to  call  "Studies  in  Paleopathology." 

Alice  Ruffer 

I.       INTRODUCTION 

Mummery's1  classical  paper  dating  from  over  forty-five  years 
ago,  to  which  I  shall  refer  repeatedly,  was  the  only  contribution  of 
any  permanent  value  regarding  the  incidence  of  dental  disease  in 
ancient  Egyptians  until  the  publication,  by  two  members  of  the 
Archaeological  Survey  (A.  S.  N.)  of  Nubia,  G.  Elliot  Smith  and 
F.  Wood  Jones,  of  the  report  on  the  human  remains  found  in  Nubia.2 
Elliot  Smith  was  responsible  for  the  anthropological  work,  the  field 
notes  and  the  whole  of  the  pathological  section  being  Dr.  Wood 
Jones's  contribution.  The  independence  of  judgment  of  both 
observers  is  demonstrated  by  the  fact  that  they  do  not  always 
entirely  agree  regarding  the  conclusions  to  be  drawn  from  their 
observations.     Their  memoir,  published  in  1010,  is  valuable,  first 

1  J.  R.  Mummery,  Trans.  Odont.  Soc.  Great  Britain,  II  (1870). 

2  Archaeological  Survey  of  Nubia,  igoy-8,  Vol.  II,  "Report  on  the  Human 
Remains,"  by  G.  Elliot  Smith  and  F.  Wood  Jones,  Cairo,  1910.  This  work  will  in 
future  be  referred  to  as  A.  S.  N. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH         269 

on  account  of  the  large  number  of  skeletons  examined,  and  second 
because  all  the  material  is  dated — a  most  important  point,  as 
Egyptian  or  Nubian  skeletons  may  belong  to  any  period  from  over 
4000  b.c.  to  the  present  time,  a  stretch  of  over  six  thousand  years. 
The  excavations  in  Nubia  brought  to  light  skeletons  dating  from 
some  time  before  dynastic  times,  that  is,  before  3400  B.C.,  down  to 
the  Coptic  and  Christian  times.  The  field  notes  are  not  the  least 
valuable  part  of  the  work  and  have  been  carefully  analyzed  by  me, 
and,  indeed,  except  for  some  observations  made1  at  Merawi  and 
Faras,  practically  the  whole  of  my  remarks  regarding  dental 
disease  in  Nubia  will  be  based  on  this  memoir. 

Interesting  facts  concerning  dental  disease  in  ancient  Egypt  are 
to  be  found  in  Elliot  Smith's  description  of  the  royal  mummies  in 
the  Museum  of  Cairo.2  A  most  valuable  collection  was  the  series 
of  skulls  discovered  by  the  Hearst  expeditions  of  the  University  of 
California.  These  are  repeatedly  alluded  to  by  Elliot  Smith  in 
several  of  his  anthropological  papers,  but  I  am  not  aware  that  a 
full  account  of  the  pathological  lesions  of  these  skulls  has  ever  been 
published;  they  are  now  in  the  United  States,  partly  at  the  Museum 
of  the  University  of  California  and  partly  at  Harvard.  The 
Museum  of  the  Medical  School  in  Cairo  contained  for  a  time  a  large 
number  of  these,  and  they,  with  additional  ancient  Egyptian  crania 
collected  by  Elliot  Smith,  Derry,  and  others,  were  repeatedly  exam- 
ined by  me.  Skulls  from  the  Naga  el  Deir,  dating  from  the  Vlth 
to  Xllth  Dynasties,  Coptic  skulls  from  the  same  locality,  and  skulls 
from  the  pyramids  of  Gizeh  belonging  to  the  IVth  and  Vth  Dynas- 
ties, were  also  studied.  All  this  material  proved  most  useful  for  form- 
ing an  opinion  as  to  the  nature  of  the  dental  and  other3  lesions,  but 

"  Marc  Armand  Ruffer,  "Note  on  the  Diseases  of  the  Sudan  and  Nubia  in  Ancient 
Times,"  Mill.  :.  Gesch.  d.  Med.  u.  d.  Nalurw.,  XIII  (1914),  453. 

2  G.  Elliot  Smith,  The  Royal  Mummies,  Cairo,  1912. 

3  Marc  Armand  Ruffer  and  Arnoldo  Rietti,  "On  Osseous  Lesions  in  Ancient 
Egyptians,"  Jour.  Path,  and  Bad.,  XVI  (191 2),  439;  Marc  Armand  Ruffer,  "Studies 
in  Paleopathology  in  Egypt,"  ibid.,  XVIII,  149;  "Pathological  Notes  on  the  Royal 
Mummies  of  the  Cairo  Museum,"  Mitt.  z.  Gesch.  d.  Med.  u.  d.  Naturw.,  XIII  (1914), 
239;  "Note  on  the  Diseases  of  the  Sudan  and  Nubia  in  Ancient  Times,"  ibid.,  453; 
(with  Arnoldo  Rietti)  "Notes  on  Two  Egyptian  Mummies,"  Ball.  Soc.  Archtol. 
d'Alcxandric,  So.  14,  3. 


270         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

owing  to  the  large  number  of  teeth  lost  in  the  graves,  it  was  practi- 
cally useless  for  a  statistical  study  regarding  the  incidence  of  any 
particular  form  of  dental  disease. 

For  part  of  the  material  on  which  this  paper  is  based,  my 
best  thanks  are  due  to  the  late  Sir  Gaston  Maspero,  to  Pro- 
fessor W.  M.  Flinders  Petrie  and  his  collaborators,  to  Professor 
G.  Elliot  Smith,  and  to  Professor  E.  Breccia,  of  the  Museum  of 
Alexandria. 

At  Chatby,  near  Alexandria,  about  two  minutes'  walk  from  the 
sea,  lie  the  tombs  of  the  Macedonian  soldiers  of  Alexander  the  Great 
and  Ptolemy  I.  In  view  of  the  constant  growth  of  the  town,  which 
will  soon  extend  over  the  whole  of  this  region,  the  Municipal  Com- 
mission ordered  an  archaeological  survey  of  this  site.  The  work 
was  entrusted  to  Professor  E.  Breccia,1  the  curator  of  the  Alexandria 
Museum,  who  gave  us  permission  to  examine  most  of  the  bones 
found  in  the  necropolis,  and  to  be  present  during  some  of  the 
excavations.  Owing  to  a  lawsuit,  the  work  has  been  suspended  for 
a  time,  and  this  delay  is  specially  unfortunate  because  the  names  on 
the  tombs  to  be  yet  opened  indicate  that  the  crypts  contain  the 
skeletons  of  the  prostitutes  who  accompanied  the  Greek  army. 
Here,  if  anywhere,  evidences  of  syphilis  should  be  found,  provided 
venereal  disease  existed  at  that  period. 

The  bodies  here  had  been  placed  in  rock-hewn  graves.  The 
first  grave  was  an  ossarium  measuring  about  2  cm.,  filled  with 
sand  and  bones,  and  closed  with  a  stone  slab  which  had  been  sealed 
with  mortar.  The  bones,  after  the  bodies  had  undergone  decompo- 
sition elsewhere,  had  been  thrown  into  the  ossarium,  and  little  care 
had  evidently  been  taken  in  their  gathering,  as  among  the  human 
bones  the  femur  of  a  horse  was  found.  The  other  graves  were 
horizontal  shafts,  3  . 5  feet  high,  6  feet  deep,  and  about  3  . 5  feet  wide, 
cut  in  the  solid  rock  and  closed  in  the  same  manner  as  the  ossarium. 
Rarely,  such  a  tomb  contained  but  one  body,  lying  on  a  layer  of 
sand  about  6  inches  deep;  as  a  rule,  several  skeletons,  five,  six,  or 
even  more,  were  present.  Funeral  urns  filled  with  ashes  or  half- 
carbonized  bones  were  discovered  also.  The  Greeks  of  that  period, 

1  This  eminent  archaeologist  will  soon  publish  a  full  account  of  his  researches, 
which  will  throw  much  light  on  the  habits  of  the  Greek  immigrants  in  Egypt. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        271 

therefore,  were  eclectic  in  their  customs,  some  families  burning, 
others  burying  their  dead. 

Unfortunately,  the  level  of  the  land  has  sunk  several  feet  since 
the  last  body  was  consigned  to  the  grave.  Hence  some  tombs  were 
partially  filled,  others  merely  infiltrated  with  sea  water,  and  the 
bones  were  often  found  lying  in  water,  or  in  thick,  wet  mud.  Such 
skeletons  were  in  bad  condition,  and  most  of  the  smaller  with  some 
of  the  larger  bones  could  not  be  found,  even  when  the  slush  was 
removed  carefully  by  hand. 

Although,  as  might  be  expected,  the  bones  were  rather  better 
preserved  in  dry  than  in  wet  graves,  yet  this  was  by  no  means  the 
rule.  The  skeleton  of  a  female,  for  instance,  lying  on  a  bed  of  dry 
sand,  was  so  fragile  that  some  bones  were  broken  when  their 
removal  was  attempted;  on  the  other  hand,  bones  lying  in  liquid 
mud  were  sometimes  very  hard,  whereas  others,  in  the  same  grave, 
broke  as  soon  as  touched. 

Sometimes  the  soldiers  had  been  buried  with  their  wives  and 
children;  nothing,  however,  could  be  learned  from  the  skeletons  of 
the  last  named,  as  hardly  a  single  bone  was  preserved  sufficiently 
well  for  examination. 

We  shall  not  enter  into  anthropometric  details,  as  the  skeletons 
have  been  handed  over  to  an  anthropologist  for  examination.  We 
may  say,  however,  that  a  superficial  examination  sufficed  to  show 
that  various  races  were  represented.  Of  the  thirty-two  skulls 
examined,  some  had  high-bridged  noses,  others  remarkably  flat 
ones.  Some  were  brachycephalic,  others  markedly  dolichocephalic ; 
two  skulls  were  evidently  negroid.  The  variations  in  stature  were 
great  also,  some  men  being  tall,  others  short.  These  differences  are 
not  to  be  wondered  at  considering  that,  from  the  start,  Alexander's 
army  was  distinctly  a  "mixed  crew."  It  is  stated,  for  instance,  in 
Smith's  Classical  Dictionary,  that  of  the  30,000  foot  soldiers  who 
left  Greece  with  Alexander,  only  12,000  were  Greeks;  the  others 
were  foreigners,  chiefly  Thracians.  The  inscriptions  on  the  tombs 
were  in  Greek,  but  it  is  highly  probable  that  the  soldiers  settled  in 
Egypt  had  intercourse  with  and  often  married  native  women,  just 
as  their  successors  have  done  in  modern  times.  The  present 
Berberine,   for  instance,  especially  when  coming  from  Korosko, 


272         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

often  boasts  that  he  is  a  descendant  of  a  Turkish  soldier  and  a  native 
woman,  and  the  name  Turk,  as  used  by  him,  includes  Greek, 
Herzegovinian,  Bosnian,  Bulgarian,  and  Servian. 

Another  part  of  our  material  was  derived  from  the  catacombs 
of  Kom  el  Shougafa,  which  are  situated  close  to  Pompey's  Pillar  at 
Alexandria,  and,  according  to  Professor  Breccia,  the  bodies  dated 
from  the  second  century  a.d.  The  tombs  contained  hundreds  of 
skeletons,  most  of  which,  owing  to  the  gradual  infiltration  of  water, 
were  in  such  a  bad  condition  that  they  could  not  be  examined.  It 
has  been  supposed  that  these  catacombs  contained  the  skeletons  of 
the  Alexandrian  youths  who  were  massacred  by  order  of  Caracalla. 
A  simple  examination  of  the  skeletons  showed  this  supposition  to  be 
wrong,  as  the  bones  were  those  of  men,  women,  and  children.  On 
the  whole,  the  mode  of  burial  was  almost  identical  with  that  seen 
at  Chatby.  The  first  body  had  been  placed  on  a  layer  of  sand 
about  4  inches  high,  and  later  on  the  skeleton  had  been  pushed  aside 
to  make  room  for  the  second  occupant. 

I  was  also  fortunate  enough  in  obtaining  fragments  of  about 
forty  Egyptian  skulls  buried  at  Ras  el  Tin  and  dating  from  the  time 
of  Cleopatra,  but  again,  these  were  quite  useless  for  statistical 
purposes;  and  I  have  examined  five  Coptic  bodies  coming  from 
Upper  Egypt  and  dating  from  the  fifth  century  a.d.,  while  other 
Coptic  bodies  were  given  me  by  Professor  Breccia  and  came  from 
Antinoe  in  Upper  Egypt.  The  bodies  of  the  latter  had  been  origi- 
nally placed  in  wooden  coffins  and  buried  in  sand.  When  handed 
over  to  me,  they  were  dressed  in  long  linen  shirts  in  which  they 
had  been  buried,  and  from  the  embroideries  adorning  these  garments 
I  concluded  that  these  persons  had  belonged  to  a  wealthy  class  of 
the  community. 

For  the  purpose  of  this  paper  the  chronology  used  in  the  Archaeo- 
logical Survey  of  Nubia1  has  been  adopted,  the  dates  being  those 
given  by  Breasted.2 
i.  Predynastic  periods:  early,  middle,  late.     These  three  periods  cannot  be 

accurately  dated,  but  they  certainly  extended  before  3400  B.C. 
2.  Early  dynastic  period  =  the  first  three  or  four  dynasties.     (Approximately 

A  group.)     3400-2750  B.C. 

1  G.  A.  Reisner,  Archaeological  Survey  of  Nubia,  Vol.  I,  Arch.  Rep.,  p.  6. 

2  History  of  Egypt,  p.  397. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        273 

3.  IVth-VTth  Dynasties.     (Approximately  B  group.)     2750-2475  B.C. 

4.  Middle    Empire  =  VHth-XVIth    Dynasties.     (Approximately    C    group.) 

2475-1600  B.C.  ( ?). 

5.  New  Empire  =  XVTIth-XXth   Dynasties.     (Same   as  D   group.)     1780- 

1200  B.C. 

6.  Late  period  =  XX th-XXXth  Dynasties.     1200-332  B.C. 

7.  Ptolemaic-Roman  period.     332  B.C. — 300  a.d. 

8.  Coptic  period.     300  A.D. 

H.      DENTAL   ANOMALIES 

The  description  includes  abnormalities  in  the  number,  position, 
and  structure  of  deciduous  and  permanent  teeth,  which  are  of  both 
medical  as  well  as  anthropological  concern. 

Irregularities  of  teeth  have  been  attributed  to  modern  civiliza- 
tion, and  are  said  to  be  rare  in  ancient  and  even  some  modern  races. 
None  were  found,  for  instance,  in  the  large  collection  of  skulls  in 
the  crypt  of  Hythe  Church,  England,  but  these,  as  a  matter  of  fact, 
were  comparatively  modern,  and  of  mixed  origin,  most  dating  from 
450  a.d.  The  frequently  quoted  comparisons  between  ancient  and 
modern  Britons,  or  between  ancient  and  modern  Italians,  are  of 
little  value,  owing  to  the  extensive  crossing  of  races  which  has  taken 
place,  few  modern  Englishmen  and  Italians  being  descendants  of 
ancient  Britons  and  Romans. 

The  causes  of  irregularities  of  teeth  in  modern  times  are  said  to 
be:  (1)  premature  removal;  (2)  persistence  of  deciduous  teeth; 
(3)  supernumerary  teeth;  (4)  mouth-breathing;  (5)  habit  of  suck- 
ing thumbs,  lips,  tongue,  or  toes;  (6)  presence  of  a  frenum  of 
the  tongue;  and  still  others.  The  only  factors  which  can  be 
appreciated  by  examination  of  skeletal  material  are  the  first 
three. 

Abnormalities  of  the  dentition  are  certainly  not  peculiar  to 
modern  times  either  in  France  or  in  Egypt.  The  dentition  of  the 
Homo  M ousteriensis  was,  as  is  well  known,  somewhat  aberrant.  The 
eruption  of  the  right  canine  had  been  delayed,  and  the  deciduous 
canine  on  the  same  side,  already  much  worn,  was  still  present.  It 
has  been  maintained  that  the  pathological  process  accompanying 
the  retention  of  the  left  deciduous  canine  had  left  traces  on  the 
corresponding  articulation,  for  the  condyle  did  not  fit  the  jaw 


274         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

exactly,  and  its  shape  differed  from  that  of  its  fellow,  being 
thicker  in  the  sagittal  direction  and  shortened  in  the  transverse 
direction. 

In  England,  abnormalities  in  the  position  of  the  teeth  have  been 
seen  in  prehistoric  remains;  at  Hailing  and  Caithness,  for  instance. 
The  third  lower  molar  of  a  skeleton  from  the  brick-earth  deposit  at 
Hailing,  Kent,  lay  obliquely  at  the  junction  of  the  ramus  and  body 
of  the  jaw,  due  to  want  of  room.1  The  left  upper  canine  from  a 
prehistoric  skull  at  Caithness  was  thrust  inwards  out  of  its  place.2 
Torsion  of  a  canine  tooth  from  the  Bronze  Age  found  at  Adlerberg,3 
and  also  from  a  Hokergrab*  at  Reiherwerder,  is  on  record.  The 
roots  of  the  molar  teeth  at  St.  Brelade's,  Jersey,  were  conjoined  or 
fused.  Abnormalities  in  the  position  and  structure  of  the  teeth 
have  been  discovered  in  several  ancient  skulls  of  France.  The 
incisors  and  canines  of  a  mandible  at  Cro-Magnon  were  compressed 
laterally  and  slightly  thrust  forward,  and  the  left  third  lower  molar 
was  smaller  than  the  others  and  had  two  roots  only.5  A  prehistoric 
skull  found  in  the  Carriere  Helie  at  Grenoble  had  an  "atrophied" 
third  molar.6  A  bifid  canine  was  found  at  Grenelle,7  and  a  cranium 
of  La  Magdaleine  had  a  very  small  third  molar  with  two  double 
roots.8  Ancient  Danish  jaws,  according  to  Nielson,  also  sometimes 
had  teeth  aberrantly  placed  or  with  an  abnormal  structure. 

These  instances,  gleaned  from  the  limited  literature  at  the 
writer's  disposal,  suffice  to  show  that  dental  abnormalities  were 
certainly  not  uncommon  in  ancient  times.  Doubtless  the  study  of 
further  records  and  the  systematic  examination  of  ancient  skulls 
would  add  materially  to  their  number. 

1  A.  Keith,  "  Report  on  the  Human  and  Animal  Remains  Found  at  Hailing,  Kent," 
Jour.  Anthr.  Inst.,  XLIV  (1014),  234. 

2  S.  Laing,  "Prehistoric  Remains  of  Caithness;  with  Notes  on  the  Human 
Remains  by  Th.  Huxley,"  Jour.  Anthr.  Soc,  London,  III  (1S65),  xx  f. 

3  P.  Barters,  "tlber  Schadel  und  Skelettreste  der  friiheren  Bronzezeit  aus  der 
Umgebung  von  Worms  am  Rhein,"  P'rdhist.  Zcitschr.,  Vol.  IV  (rcji2),  Nos.  1-2. 

4  Busse,  "Graber  mit  Hokerbestattung  und  Flachgraber  auf  dem  grossen  Reiher- 
werder im  Tegeler  See,"  Prahist.  Zcitschr.,  II  (igio),  60-78. 

5  Quatrefage  et  Hamy,  Crania  cthnica,  p.  49. 

6  Ibid.,  p.  120. 

I  Ibid,.,  p.  86.  %Ibid.,  p.  55. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        275 

ABNORMALITIES   OF  DENTITION  IN  ANCIENT  EGYPTIANS 

The  supernumerary  teeth  of  modern  peoples  are  often  like 
normal  teeth  in  shape  and  character.  They  are  more  frequent  in 
the  upper  than  in  the  lower  jaw.  They  resemble  a  lateral  incisor 
most  often,  a  premolar  less  frequently,  molar  rarely,  and  a  canine 
very  exceptionally.  The  last  point,  however,  calls  for  a  qualifica- 
tion: small  conical  supernumeraries  are  not  uncommon,  but  they 
are  more  like  the  deciduous  canines,  or  like  the  ancestral  conical 
teeth,  which  they  possibly  represent,  than  like  the  permanent 
canines.1  They  occur  most  commonly  in  the  upper  incisor  region. 
Two  supernumerary  teeth  are  occasionally  met  with  in  the  premolar 
region,  and  a  supernumerary  tooth  not  infrequently  erupts  near, 
mostly  posterior  to,  the  third  molar.  Supernumerary  first  and 
second  molars  have  never  been  recorded. 

Supernumerary  teeth  have  been  reported  before  in  ancient 
Egyptian  skulls. 

A  very  curious  case  dates  from  the  Xllth  Dynasty.2  The  two 
left  maxillary  incisors  of  a  youngish  man  were  joined  together  and 
formed  a  large  tusk,  which  certainly  did  not  add  to  the  bearer's 
good  looks  during  life,  and  an  accessory  incisor  tooth  had  perforated 
the  palate  behind  this  extraordinary  structure. 

A  young  Nubian  woman3  of  the  New  Empire  period,  with 
normal  teeth,  had  a  supernumerary  tooth,  situated  3  mm.  within 
the  nasal  margin,  and  unconnected  with  the  normal  alveolar  cavi- 
ties. It  was  conical  in  shape,  visible  from  the  front,  measured 
5  mm.  in  its  antero-posterior  diameter,  and  its  visible  portion  was 
covered  with  enamel.  In  the  second  case,  an  adult  woman  from 
the  same  grave  and  a  possible  relation  of  the  first,  the  supernumer- 
ary tooth  had  appeared  in  the  palate  to  the  left  of  the  middle  line 
behind  the  first  incisor,  and  just  externally  to  the  anterior  palatine 
foramen. 

Supernumerary  incisors  were  seemingly  rare  in  the  ancient 
Nubians,  and  the  writer  has  found  but  one  case  on  record.     In  this 

■A.  HrdliCka,  "Physiological  and  Medical  Observations  among  the  Indians," 
etc.,  Bur.  Am.  Ethnol.,  Hull.  34,  Washington,  1908,  p.  124. 

'  M.  A.  Murray,  "The  Tomb  of  Two  Brothers,"  The  Manchester  Museum  Hand- 
books, PI.  II,  Fig.  4. 

1  A.  S.  JV.,  p.  230. 


276         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

person,  the  tooth  had  erupted  immediately  to  the  inner  side  of  the 
left  maxillary  second  incisor.1  Similarly,  only  one  instance  of  a 
supernumerary  canine  has  been  described,  and  this  was  situated 
just  behind  the  left  maxillary  canine  of  no  less  a  personage  than 
Queen  Nefer  buried  at  Dahshur.2  Supernumerary  premolars 
were  found  in  two  Nubian  negroes  only,  who,  as  they  occupied 
neighboring  graves,  may  also  have  been  relations.  Each  had  a 
supernumerary  tooth  near  the  posterior  normal  premolar;  otherwise 
the  jaws  were  normal  with  no  signs  of  crowding.  The  abnormality 
most  often  found  in  the  molar  region  of  Nubians  was  the  presence 
of  one  or  two  supernumerary  molars. 

As  to  Egypt  proper,  a  supernumerary  central  upper  incisor,  and 
a  small  supernumerary  intercalated  between  the  second  and  third 
right  lower  molars,  were  found  by  the  writer  in  one  out  of  156 
Egyptian  predynastic  maxillae  and  35  mandibles.  The  fourth 
molars  will  be  discussed  with  the  abnormalities  of  the  molar  region. 
In  a  skull  from  Faras,  dating  from  about  300  B.C.,  the  teeth  had  all 
fallen  out  after  death,  but  the  alveolus  of  a  supernumerary  was 
plainly  visible  to  the  outer  side  of  the  normal  first  molar.  Neither 
among  the  Macedonian  soldiers,  nor  among  the  Copts,  nor  among 
the  ancient  population  of  Alexandria  were  any  supernumerary  teeth 
discovered.  Attention  has  been  drawn  to  certain  "accessory  dental 
masses,"3  which  were  seen  somewhat  frequently  in  Nubia,  most  of 
them  in  the  alveolar  margin  posterior  to  the  normal  second  molars. 
These  have  been  considered  as  rudimentary  teeth,  or  perhaps  more 
correctly  as  the  remains  of  the  roots  of  deciduous  teeth.4 

The  preceding  data,  while  somewhat  fragmentary  and  not  fit  for 
exact  comparisons,  indicate  that  while  supernumerary  teeth  did 
occur  among  the  Egyptians  and  Nubians,  they  were  not  very 
frequent. 

Deficiency  in  the  number  of  teeth  may  be  studied  next. 

In  modern  people  the  missing  elements  are  almost  restricted  to 
the  third  molars,5  the  upper  lateral  incisors,  and  the  second  man- 

1  Ibid.,  p.  170. 

2  J.  de  Morgan,  Fouittes  de  Dahshur  (1894),  p.  49. 

*A.S.  N.,p.  238.  "F.  Dixon,  Proc.  B.A.A.S.,  190S. 

sL.  E.  Colyer,  in  Smale  and  Colyer's  Diseases  and  Injuries  of  the  Teeth,  1901. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH         277 

dibular  premolars.  Cases  where  many,  most,  or  even  all  the  teeth 
are  absent  are  not  unknown ;  but  these  are  pathological  cases,  and 
the  condition  may  be  associated  with  great  abundance  of  hair, 
malformation,  and  other  pathological  conditions. 

Reduction  in  the  number  of  teeth  not  due  to  disease  or  interfer- 
ence was  rare  in  ancient  Nubia.  In  a  middle  Nubian  Christian 
there  were  only  one  upper  bicuspid  and  two  upper  molar  teeth  on 
each  side  (lower  jaw?).  Another  Nubian  skull  showed  a  similar 
condition.  An  Egyptian  predynastic  skull  from  Naga  el  Deir  had 
no  left  lateral  upper  incisor,  and  the  corresponding  right  incisor  was 
very  small,  besides  which  the  right  first  molar  was  distinctly  twisted. 
A  skull  from  the  same  period  had  no  left  upper  central  incisor,  in 
spite  of  an  exceedingly  roomy  palate.  A  similar  abnormality  has 
been  noticed  in  an  ancient  Egyptian  animal.  A  monkey,  Papio 
annlis,  from  Thebes,1  had  three  maxillary  incisors  instead  of  four, 
one  being  missing  on  the  left  side.  This  deficiency  was  probably 
congenital,  as  there  was  no  alveolus,  and  the  median  line  of  the 
premaxillary  was  displaced  to  the  left,  causing  marked  asymmetry. 
Petrie,2  in  his  excavations  of  Hyksos  and  Israelite  cities,  found  a 
female  human  jaw  which  had  only  one  molar  on  each  side  and  was 
peculiarly  wide  and  short  (2.4  cm.  wide  and  only  1.2  cm.  from 
back  to  front,  forming  a  semicircle). 

Absence  of  the  first  left  mandibular  incisor  must  have  been 
fairly  common  in  Lower  Egypt,  as  four  such  cases  have  been 
observed  in  ancient  Alexandrian  skulls. 

Gaps,  or  diastemae,  between  the  teeth  sometimes  occurred  in 
ancient  Nubians.  In  an  adult  man3  of  the  early  dynastic  period, 
a  space  of  4  mm.  existed  between  each  upper  lateral  incisor  and 
the  canine;  his  jaws  were  large  and  his  teeth  excellent;  another 
adult  man4  of  the  same  period  showed  a  gap  of  3  mm.  in  the  same 
position,  and  another  of  3  mm.  between  the  left  lower  canine  and 
the  first  premolar.  An  Egyptian  predynastic  skull  from  Naga  el 
Deir  had  a  large  gap  between  the  central  incisors. 

Retained  deciduous  teeth  occurred  at  all  periods  in  Nubia. 
The  left  maxillary  deciduous  canine  of  a  predynastic  young  Nubian 

1  Lortet,  Lafaune  momifiec  de  V&gyplc,  SGrie  II,  p.  11. 

■  IJyksos  and  Israelite  Cities.  >  A.  S.  N.,  p.  208.  «  Ibid.,  p.  180. 


278         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

woman  of  the  middle  period,  for  instance,  was  retained  directly  to 
the  outer  side  of  the  permanent  canine,1  the  retention  being  com- 
bined with  malposition  of  the  teeth.  The  left  upper  second  decidu- 
ous incisor  of  an  adult  male  of  the  early  dynastic  period  was  retained 
upon  the  palatal  side.  In  a  woman  of  the  Byzantine  period,  the 
permanent  upper  canine  was  displaced  towards  the  palate,  and  the 
retained  deciduous  canine  occupied  exactly  the  normal  position. 
A  Nubian  woman  of  the  predynastic  period  showed  exactly  the  same 
condition  on  the  left  side.  Retained  teeth  were  rare  in  predynastic 
and  later  Egyptians,  but  Petrie2  mentions  the  case  of  a  predynastic 
adult  with  erupted  wisdom  teeth  whose  permanent  canines  had 
been  retained. 

There  is  no  evidence  to  show  that  retardation  of  the  eruption  of 
the  permanent  teeth  was  at  all  common  in  Egypt.  Still,  except  in 
Nubia,  crowding  and  malposition  of  teeth  were  not  rare.  Crowding 
of  the  teeth  was  observed  by  the  author  in  7  out  of  156  Egyptian 
predynastic  skulls.  The  left  canine  and  the  two  premolars  of  one 
skull  were  so  pressed  together  as  to  overlap ;  in  four  other  cases,  the 
crowding  was  limited  to  the  front  teeth,  incisors,  and  canines,  and 
in  one  the  crowding  was  evidently  due  to  the  size  of  the  incisors 
which  had  not  permitted  the  canines  to  assume  their  normal  place. 

Various  malformations  of  teeth  were  observed,  but  as  a  rule 
they  affected  the  roots  chiefly.  The  roots  of  the  first  molar  of  a 
predynastic  skull  in  the  Cairo  Museum,  for  example,  were  fused 
together  into  a  mass  filling  the  greatly  distended  alveolus.  Fusion 
of  two  or  three  roots  was  not  rare  in  Alexandrian  skulls,  though  it 
was  seldom  as  marked  as  in  the  preceding  case,  and  in  Egyptian 
predynastic  skulls  abnormalities  of  the  roots  were  possibly  fairly 
common.  The  right  mandibular  canine  (predynastic)  had  two 
roots  in  two  cases,  and  in  another  skull  of  the  same  epoch  both 
maxillary  second  premolars  also  had  two  roots.3 

Occasionally  abnormalities  of  the  cusps  were  seen.  A  second 
upper  molar  had  five  cusps ;  both  first  molars  of  one  mandible  had 

'A.  S.  N.,  p.  165.  2  Tarkhan,  I,  and  Memphis,  V,  11. 

3  It  is  not  possible  to  ascertain  abnormalities  of  the  roots  without  taking  out  the 
teeth.  This  could  not  be  done,  but  the  observations  are  based  on  teeth  which  had 
accidentally  dropped  out,  and  are  therefore  valueless  for  statistics. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        279 

six  cusps,  and  two  mandibular  first  molars  from  two  different  skulls 
had  the  same  number.  All  these  belonged  to  the  Egyptian  pre- 
dynastic  period. 

The  Egyptian  teeth,  as  a  rule,  were  very  regularly  planted  except 
in  cases  of  overcrowding ;  usually  the  "  bite  "  was  good  and  marked 
overbites  were  rare. 

At  Ras  el  Tin,  overbites  were  present  in  three  skulls.  The 
maxillary  and  mandibular  incisors  and  canines  of  the  first  skull  did 
not  meet.  A  similar  defect  was  present  in  the  skull  of  a  young 
adult  whose  teeth  were  otherwise  perfect.  Lastly,  a  skull  with 
molars  still  unerupted  had  overlapping  central  mandibular  incisors. 

A  curious  malformation  was  observed  in  the  skull  of  a  young 
person.  The  right  upper  canine  Was  inclined  almost  directly  for- 
wards, and  the  neighboring  premolar  being  in  its  normal  position, 
the  roots  of  the  premolar  and  canine,  necessarily  crossing,  touched 
one  another,  with  chronic  periostitis  at  the  point  of  contact  as  the 
result.  The  alveolar  walls  of  the  other  teeth  had  suffered  severely 
from  chronic  rarefying  periostitis,  the  posterior  root  of  the  maxillary 
right  second  molar,  for  instance,  being  almost  completely  bare. 
The  maxillary  right  first  molar  and  right  second  incisor  had  been 
lost  during  life,  and  there  was  no  germ  of  a  maxillary  right  third 
molar. 

Anomalies  in  the  region  of  the  third  molars  were  often  met  with. 
Pits  in  the  alveolar  process  behind  the  third  molar  were  seen  very 
commonly  in  ancient  negroid  Nubians,1  and  also  in  predynastic  and 
dynastic  skulls.  These  pits  were  sometimes  superficial,  or  formed  a 
cavity  several  millimeters  in  depth,  and  it  has  been  suggested  that 
their  frequency  was  connected  with  the  roominess  of  the  jaw.  It 
is  not  unlikely  that  some  of  these  alveoli  actually  contained  teeth. 

Fourth  molar  teeth  were  found  in  Nubia  in  a  few  cases  only.2 
An  adult  negroid  man  had  fourth  molars  as  large  as  normal  molars, 
and  in  a  negroid  woman  of  the  Byzantine  period,  a  well-formed  and 
large  fourth  molar  had  erupted  upon  the  right  side  of  the  upper  jaw. 
Upon  the  left  side  there  was  a  deep  groove,  like  an  empty  alveolar 
cavity,  which  corresponded  to  the  fully  developed  tooth  upon  the 
opposite  side.     In  another  case  of  the  anomaly,  the  condition  was 

'  A.  S.  A'.,  p.  165.  '  Ibid.,  p.  237. 


280         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

associated  with  a  peculiar  dentition:  the  right  mandibular  third 
molar  was  just  visible,  the  corresponding  left  tooth  was  absent,  and 
the  maxillary  third  molar  was  still  retained  in  the  alveoli.  On  the 
whole  it  may  be  said  that  less  than  i  per  cent  of  predynastic  and 
dynastic  Egyptians  had  a  fourth  molar,  and  no  case  was  met  with 
in  Alexandria. 

Absence  of  the  third  molars  on  one  or  both  sides  was  present  in 
a  Nubian  skull  from  the  middle  predynastic  times,  which  had  also 
a  retained  deciduous  left  maxillary  canine,  situated  just  to  the  outer 
side  of  the  permanent  canine.  In  156  predynastic  skulls  examined 
by  the  author,  one  or  both  third  molars  were  absent  in  19,  namely: 
the  right  upper  in  5,  the  left  upper  in  3,  both  uppers  in  7,  the  right 
lower  in  1,  the  left  lower  in  2,  and  both  lowers  in  1.  The  jaws  were 
roomy  in  some  of  these  cases,  so  that  lack  of  room  could  not  be 
generally  adduced  as  a  reason  for  this  anomaly.  Unilateral  absence 
of  one  third  molar  occurred  in  no  less  than  7  per  cent  of  all  the  adult 
Alexandrian  skulls  dating  from  about  300  B.C.,  although  the  jaws 
were  large  and  the  teeth  not  crowded. 

Anomalies  in  size  and  position  of  the  third  molars  were  not  at 
all  rare  in  Egyptian  predynastic  people. 

The  upper  third  molars  were  noticeably  smaller  than  the  other 
molars  in  45  Egyptian  predynastic  skulls  of  156,  and  in  19  out  of 
35  mandibles.     In  45  the  smallness  was  bilateral. 

The  following  anomalies  were  also  present:  case  1,  left  lower 
third  molar,  one  root  only;  case  2,  left  lower  third  molar,  two  roots 
only;  case  3,4,  5,  and  6,  left  lower  third  molar,  root  very  small,  not 
more  than  a  peg;  case  7,  left  lower  third  molar,  two  roots  only. 
In  one  upper  jaw  the  third  molars  were  probably  impacted. 

The  following  anomalies  were  met  with  in  112  skulls  from 
Thebes.1  First,  adult  female:  The  third  upper  molar  was  twisted 
on  account  of  want  of  room,  so  that  its  masticating  surface  was 
turned  outwards.  The  same  alteration,  though  to  a  slighter  extent, 
was  seen  in  nine  other  upper  jaws.  In  4  cases,  the  mandibular 
third  molar  was  twisted  inwards  and  forwards.  Secondly,  in 
several  cases  (exact  number  not  stated)  the  alveolar  border  was 
prolonged  so  as  to  leave  room  for  a  possible  fourth  molar.     Thirdly, 

1  Hermann  Stahr,  Die  Rassenfrage  im  antiken  Agypten,  Berlin,  1907. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        281 

in  the  following  cases  one  or  more  third  molars  were  absent:  (a)  one 
rudimentary  left  lower  third  molar  only  had  erupted;  (6)  male 
adult,  no  upper  third  molars;  (c)  young  male,  no  germs  for  upper 
third  molar;  (d)  male  adult,  no  third  molars;  (e)  adult  female,  no 
upper  third  molars;   (/)  adult  female,  no  lower  third  molars. 

Abnormalities  in  size  were  very  common  also.  In  n  cases,  the 
second  molars  were  smaller  than  the  third  molars;  in  7  cases 
the  third  molars  were  larger  than  the  first  and  second  molars; 
whereas  in  three  skulls  some  of  the  third  molars  were  larger,  and 
the  others  smaller  than  the  other  molars. 

At  Ras  el  Tin  also,  in  skulls  dating' from  the  time  of  Cleopatra, 
several  abnormalities  of  the  third  molars  were  observed.  The  right 
maxillary  third  molars  were  absent  in  three  adults,  and  the  corre- 
sponding teeth  on  the  other  side  in  three  others.  Moreover,  mal- 
positions of  these  teeth  were  common.  In  two  cases,  the  right  third 
lowermolarwas  planted  at  the  base  and  on  the  inside  of  the  ascending 
ramus,  so  that  the  tooth  was  invisible  when  the  mandible  was  looked 
at  from  the  side.  The  left  third  lower  molar  of  another  skull, 
though  firmly  planted,  was  almost  horizontal.  A  similar  curious 
deformation,  not  due  to  an  accident,  was  that  of  a  left  third  lower 
molar  which  was  almost  horizontal,  being  implanted  at  the  base  of, 
and  at  right  angles  to,  the  ascending  ramus.  The  tooth  had  not 
been  used  at  all  for  mastication,  for  its  crown,  in  contrast  to  those 
of  the  other  teeth,  showed  no  sign  of  attrition.  The  same  mal- 
formation existed  in  still  another  mandible.  Lastly,  the  upper 
third  molars  of  three  middle-aged  persons  were  noticeably  smaller 
than  the  corresponding  second  molars. 

In  the  Macedonians  buried  at  Chatby,  the  small  size  of  many 
third  molars  was  striking. 


Enamel  nodules  or  pearls  are  small  enamel  excrescences  or  drop- 
lets, occasionally  met  with  on  the  roots  of  teeth.  They  are  gener- 
ally found  upon  multirooted  teeth,  being  situated  a  little  below  the 
neck  and  often  at  the  junction  of  two  roots.  On  section  they  are 
seen  to  consist  of  a  cone  of  dentine  covered  with  a  rather  thick 
layer  of  enamel.     Only  one  such  nodule  was  seen  in  the  Egyptians, 


282         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

but  as  many  of  the  molar  teeth  were  lost,  this  cannot  be  taken  as 
a  proof  of  the  rarity  of  this  condition. 

Dental  anomalies  lead  at  times  to  trouble,  as  illustrated  by  the 
following  case.  The  anterior  left  part  of  the  upper  jaw  of  a  Nubian 
Christian  was  in  a  state  of  very  acute  inflammation  starting  from 
the  alveolar  cavities  of  the  front  teeth.  A  large  part  of  the  alveolar 
margin  was  necrosed,  the  septic  process  had  spread  in  various 
directions,  and  the  large  anterior  abscess  cavity,  communicating 
freely  with  the  antrum  of  Highmore,  also  opened  on  the  palate  by 
a  large  sinus.  The  process  had  spread  up  the  nasal  duct,  and  to 
the  inner  wall  of  the  left  orbit.  A  sinus  opened  upon  the  surface 
of  the  superior  maxilla  behind  and  upon  the  first  left  premolar  tooth. 
An  irregular  mass  representing  the  conjoined  roots  of  the  front 
teeth  occupied  the  large  abscess  cavity.  The  root  of  the  anterior 
premolar  and  the  roots  of  the  two  teeth  immediately  anterior 
to  it  were  joined  together  into  one  solid  mass,  and  all  had  been 
the  site  of  an  acute  septic  dental  disease. 

III.      WEAR 

The  intensity  of  attrition  is  said  to  depend  largely  on  the  nature 
of  the  food,  the  density  of  the  tooth  substance,  and  lastly  on  the 
character  of  the  bite.  All  the  teeth  are  involved,  as  a  rule,  and 
when  a  few  teeth  only  are  worn  this  anomalous  condition  is  almost 
always  due  to  an  irregularity  of  the  dentition. 

The  change  proceeds  slowly  until  the  enamel  has  been  worn 
away  and  much  more  speedily  afterwards.  As  the  upper  incisor 
and  canine  teeth  of  normal  persons  bite  somewhat  in  front  of  the 
lower  teeth,  attrition  is  usually  more  conspicuous  on  the  lingual 
side  of  the  former  and  on  the  labial  side  of  the  latter.  Moreover, 
the  slope  of  the  upper  and  lower  teeth  towards  one  another  produces 
a  corresponding  slant  in  the  masticating  surfaces,  which  increases 
as  the  attrition  gets  more  pronounced;  the  worn-down  crowns  of 
the  upper  incisors,  for  instance,  are  usually  inclined  obliquely 
towards  the  lingual  side,  whereas  those  of  the  lower  incisors  tend 
to  slope  in  the  opposite  direction. 

Nowadays  attrition  is  a  characteristic  of  people  living  on  raw, 
fibrous,  vegetable  food  (Egyptian  fellaheen),  of  old  people,  and  of 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH         283 

deciduous  teeth  in  their  last  stages,  and  great  individual  differences 
exist  both  in  its  mode  and  degree.  Should  the  food  consist  of  hard 
seeds,  roots,  or  tough  meat,  attrition  is  most  marked  on  the  lingual 
side  of  the  upper,  and  the  labial  side  of  the  lower  teeth.  In  people 
living  on  rich,  nitrogenous  food,  the  pulp  is  generally  replaced  by 
secondary  dentine  and  the  tooth  is  often  worn  down  to  the  neck, 
without  the  formation  of  an  alveolar  abscess;  whereas,  when  the 
food  is  deficient,  inflammation,  abscesses,  and  extensive  resorption 
of  the  alveoli  are  common. 

There  are  generally  recognized  four  degrees  of  attrition.1  In 
the  first  degree  the  enamel  is  abraded  without  obliteration  of  the 
cusps  or  exposure  of  the  dentine.  The  second  is  characterized  by 
disappearance  of  the  cusps  and  partial  exposure  of  the  dentine. 
When  the  height  of  the  tooth  is  reduced  still  further  the  third  stage 
is  reached,  characterized  by  a  complete  dentine  exposure,  and  in  the 
fourth  stage,  the  wear  extends  to  the  neck,  the  crown  having  entirely 
disappeared.  It  is,  however,  often  difficult  to  place  a  tooth  in  any 
of  these  divisions,  as  different  parts  of  the  masticating  surface  of 
one  tooth  may  exhibit  more  or  less  intense  stages  of  attrition.  A 
first  molar,  for  instance,  may  be  worn  down  to  the  gums  on  the 
labial  or  lingual  side,  but  the  rest  of  its  crown  may  be  almost  normal. 
In  this  paper  no  use  will  be  made  of  any  classification. 

Ancient  peoples,  like  uncivilized  modern  ones,  used  their  teeth 
for  many  purposes,  which  may  account  for  some  severe  lesions,  in 
which  connection  may  be  recalled  the  professional  attrition  of  the 
teeth  of  cigar-makers,  seamstresses,  pipe-smokers,  or  that  produced 
by  the  clasps  of  artificial  teeth. 

Attrition  was  very  common  in  the  teeth  of  ancient  peoples  of 
Europe,  Asia,  and  Africa.  The  human  teeth  found  in  the  Thames 
mud  at  Tilbury,  for  instance,  showed  this  change  to  a  very  marked 
extent.  The  lesions  in  the  teeth  of  the  Tilbury  skull  have  been 
observed  in  other  ancient  British  crania,  e.g.,  in  the  earliest  skull 
lately  found  in  Kent.  The  severity  of  the  attrition  in  the  prehis- 
toric teeth  found  at  Caithness  and  elsewhere  varies  somewhat,  it  is 
said,  according  to  period.     The  teeth  of  the  skull  found  in  the 

P,  Broca,  "Instructions  relatives  a  l'etudcanthropologiquedu  systemedentairc," 
Hull.  Sor.  Autlir.,  I'aris,  II  (1870J,  149. 


284         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

brick-earth  deposit  of  Hailing,  Kent,  had  been  ground  until  only- 
half  the  crown  remained,  and  it  has  been  mentioned  that  both  in  the 
Tilbury  and  Hailing  skulls,  the  teeth  were  not  lost  through  the 
modern  disease  of  caries,  but  by  exposure  of  the  pulp  cavities  with 
the  consequent  formation  of  abscesses  at  the  root  of  the  teeth. 
Certain  it  is  that  in  late  Palaeolithic  and  early  Neolithic  times  tooth 
wear  and  alveolar  abscesses  were  not  uncommon.1 

The  teeth  of  the  Bronze  Age  are  stated  not  to  be  worn  as  deeply 
as  those  of  the  Saxon  or  Middle  English  period.  A  very  charac- 
teristic first-  to  second-degree  attrition  disfigures  the  teeth  of  the 
Heidelberg  as  well  as  the  Neanderthal  jaws,  and  a  wear  of  a  more 
pronounced  nature  is  seen  in  the  jaws  of  Gibraltar  and  Chapelle- 
aux-Saints. 

In  the  teeth  of  ancient  Germans,  attrition  beyond  a  certain  age 
was  the  rule.  The  prehistoric  skulls  from  Reiherwerder2  and 
Halberstadt3 — to  mention  only  those  more  lately  discovered —  show 
a  marked  degree  of  wear.  Similar  lesions  are  noticeable  in  the  teeth 
of  ancient  Frenchmen.  The  teeth  of  the  skeleton  of  Chancelade, 
for  instance,  dating  from  near  the  end  of  the  Quaternary  period,  are 
worn  down,  while  numberless  other  examples  of  attrition  are  men- 
tioned in  French  memoirs.  Wear  is  also  well  marked  in  the  teeth 
of  the  Most  or  Brux  skull  of  Bohemia,  in  the  Ochoz  jaw  of  Moravia, 
in  the  older  individuals  of  the  Maska's  Moravian  mammoth- 
hunters,  and  in  still  other  old  specimens  from  the  central  and  other 
parts  of  Europe.  The  teeth  of  prehistoric  children  even  show  attri- 
tion in  some  instances,  and  the  same  is  well  marked  in  young  adults 
from  La  Chaumiere,4  Cro-Magnon,  Montrejeau,  Barma  Grande,5 
etc.     The  skulls  from  Swiss  pile  dwellings  show  like  alterations.6 

1  W.  H.  Cook,  "On  the  Discovery  of  a  Human  Skeleton  in  a  Brick-Earth  Deposit  in 
the  Valley  of  the  River  Medway  at  Hailing,  Kent";  A.  Keith,  "Report  on  the  Human 
and  Animal  Remains  Found  at  Hailing,  Kent,"  Jour.  Anthr.  Inst.,  XLIV  (1914). 

2  Hans  Virchow,  "Die  Schadel  von  Reiherwerder,"  Prahist.  Zcitschr.,  II  (roio),  78. 

3  A.  Schliz,  "Untersuchungsbericht  iiber  drei  Schadel  aus  dem  Halberstadter 
Museum,"  Prahist.  Zeitschr.,  IV  (1912),  377. 

4  Quatrefage  et  Hamy,  Crania  ethnica,  pp.  49,  114;  also  French  anthropological 
periodicals. 

5  R.  Verneau,  L'homme  de  la  Barma  Grande,  1893. 

6  Marcel  Baudouin,"De  l'usure  des  dents  chez  l'homme  du  paleolithique  inf£rieure 
et  moyen,"  Arch.  Prov.  d.  Chirur.,  XXI,  66. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        285 

The  teeth  of  ancient  Egyptians  were  frequently  worn  down  in 
a  characteristic  fashion.  The  most  prominent  parts  of  the  crown, 
the  cusps,  were  the  first  to  vanish,  the  masticating  surfaces  being 
ground  fiat.  This  stage,  however,  was  seen  in  ancient  Egyptians 
only  exceptionally,  as  even  in  young  adults  attrition  had  usually 
passed  this  stage.  At  this  early  period,  in  the  maxilla,  a  thin 
groove,  not  more  than  1  mm.  wide  and  5  mm.  deep,  formed  along 
the  whole  length  of  the  cutting  surface  of  the  incisors;  and  the 
crown  of  the  canine  was  hollowed  into  an  irregular,  roughly  lozenge- 
shaped  cavity,  similar  to  that  which  had  formed  by  that  time  on 
the  labial  side  of  the  crown  of  the  neighboring  premolar.  Very 
often,  also,  the  Ungual  border  of  the  canine  was  worn  down  some- 
what obliquely,  even  when  the  enamel  was  apparently  intact. 

At  that  stage,  two  shallow  cavities,  separated  by  a  bridge  of 
strong,  normal  dentine,  had  formed  on  the  masticating  surfaces  of 
upper  premolars,  the  bow-  or  half-moon-shaped  cavity  on  the  lin- 
gual side  being  always  the  deeper  of  the  two,  with  its  convex  bor- 
der towards  the  proximal  side.  The  other,  shallower  cavity  was 
irregularly  lozenge-shaped. 

The  masticating  surfaces  of  the  first  upper  molars  with  few 
exceptions  were  the  chief  sufferers,  and  the  cavities  produced  by 
attrition  were  very  irregular  and  not  easily  described,  as  may  be 
seen  from  the  appended  photographs.  (Plates  LV-LXII.)  The 
cavity  first  formed  was  deeper  near  the  lingual  and  proximal 
borders  close  to  the  second  premolar,  and  the  attrition  of  these 
teeth  was  conspicuous  even  before  the  second  molar  tooth  had 
erupted.  Later  on,  the  changes  in  the  second  molar  teeth  might 
still  be  slight  when  the  attrition  of  the  first  molars  was  already  far 
advanced.  The  masticating  surfaces  of  this  tooth  were  ground 
flat  or  a  small,  bow-shaped  cavity  occupied  the  Ungual  side,  with 
another  just  showing  close  to  it,  and  at  this  stage  the  third  molar 
tooth  was  still  practicaUy  normal. 

A  more  advanced  degree  of  wear  was  characterized  by  the  forma- 
tion of  a  large  cavity  in  the  masticating  surfaces  of  all  the  teeth. 
In  the  incisors,  the  single  cavity  previously  described  became 
deeper;  in  the  other  teeth,  the  bridge  of  dentine  separating  the 
two  cavities  previously  formed  was  worn  away  and  the  cavities 


286         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

coalesced,  but  the  attrition  of  the  first  molars  was  always  more 
marked  than  that  of  the  other  teeth. 

The  changes  in  the  lower  teeth  resembled  those  in  the  upper 
teeth,  save  that  the  cavities  formed  in  the  crowns  were  deeper  on 
the  labial  side. 

As  attrition  proceeded,  the  dentine  surrounding  the  cavities 
gradually  disappeared,  the  crown  was  worn  deeper  and  deeper,  until 
the  masticating  surfaces  were  just  above  the  level  of  the  gums. 
The  pulp  cavity  was  then  often  widely  open  and  unprotected,  and 
at  the  same  time  the  masticating  surfaces,  sloping  more  and  more, 
formed  an  acute  angle  with  the  fangs. 

The  attrition  of  the  posterior  half  or  two-thirds  of  the  masticat- 
ing surface  of  the  third  molar  was  often  peculiar  in  so  far  that  the 
worn  surface  looked  directly  backwards  and  more  or  less  down- 
wards. The  same  irregularity  was  often  seen  in  the  second  molar 
when  the  third  molar  had  fallen  out,  and  was  conspicuous  in  any 
tooth  which  had  no  immediate  neighbor  behind  it.  Other  irregu- 
larities in  attrition,  caused  by  irregularities  in  the  dentition,  need 
not  be  discussed  here,  as  they  were  of  no  special  significance.  The 
general  health  of  the  teeth  was  not  necessarily  affected  by  attrition, 
and  in  some  ancient  Egyptians,  the  teeth,  although  worn  down  to 
the  roots,  were  healthy  otherwise.  This,  however,  was  the  excep- 
tion rather  than  the  rule,  for,  as  will  be  shown  later,  alveolar  and 
perialveolar  abscesses  were  often  unmistakably  caused  by  infection 
through  teeth  opened  by  attrition. 

In  Egypt  and  Nubia  attrition  of  the  teeth  has  been  the  rule 
from  the  earliest  times  to  the  present.  Predynastic  Nubian  teeth 
were  levelled  down  uniformly,  whereas  in  more  modern  times,1  it  is 
said,  a  deep  cavity  forms  in  the  centers  of  the  crowns,  and  hence  a 
distinction  is  made  between  the  mode  of  attrition  in  ancient  and 
that  in  more  modern  Nubians.  The  distinction  cannot  be  proved, 
as  the  formation  of  a  central  cavity  is  only  one  of  the  stages  of 
attrition,  but,  nevertheless,  the  study  of  several  hundreds  of  skulls 
did  suggest  that  the  teeth  were  ground  down  evenly  in  some  cases, 
whereas  in  others  attrition  was  characterized  by  the  formation  of 
deep  cavities,  surrounded  by  a  ring  of  strong  dentine. 

1  A.  S.  N.,  p.  279. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH         287 

At  Merawi  in  Nubia  most  of  the  teeth  were  ground  down,  and 
although  attrition  had  evidently  progressed  rapidly  in  early  youth, 
yet  it  was  never  as  marked  as  in  predynastic  skulls  or  in  those  of 
modern  Egyptians.  The  change  had  apparently  taken  place  in  old 
people  at  a  much  slower  rate  than  in  the  young,  and  probably  it 
had  sometimes  stopped  altogether  in  the  old. 

In  Egypt  the  teeth  of  people  of  the  Ancient,  Middle,  and  New 
Empires,  of  Greek,  Roman,  and  early  Coptic  times,  were  all  more 
or  less  affected  by  attrition.  The  change  was  conspicuous  in  people 
of  every  class — in  the  cemeteries  of  common  folks,  in  the  priests  of 
Deir  el  Bahri,  in  the  rich  Alexandrians  of  Greek  and  Roman  times, 
and  even  in  some  royal  personages.  The  teeth  of  Ramses  II,  for 
instance,  show  marked  attrition.1 

Universal  though  attrition  was,  its  severity  appeared  to  vary. 
It  was  perhaps  most  marked  in  Upper  Egypt,  including  Nubia,  and 
in  very  ancient  predynastic  times,  and  least  conspicuous  in  Lower 
Egypt  among  the  Greek,  Roman,  and  Egyptian  populations  of 
Alexandria.  Whereas,  for  instance,  the  teeth  of  even  young  sub- 
jects from  predynastic  Egypt  and  Nubia  were  much  worn,  those 
from  the  young  people  buried  at  Kom  el  Shougafa,  Ras  el  Tin,  and 
Chatby  and  its  neighborhood  were  often  almost,  if  not  quite,  nor- 
mal. The  crowns  of  the  teeth  of  Nubian  or  upper  Egyptian  adults 
from  predynastic  times  were  often  level  with  the  gums,  whereas 
this  was  never  observed  in  Alexandrians,  not  even  among  old 
people. 

The  degree  of  attrition  has  been  used  by  anthropologists  as  a 
guide  in  the  estimation  of  age,  but  there  are  several  points  which 
must  be  remembered  before  definite  conclusions  can  be  drawn  in 
this  respect,  the  most  important  of  which  is  that  the  condition  is 
sometimes  very  pronounced  in  young  people.  The  attrition  of  the 
teeth  of  the  Homo  Aurignacensis  was  more  pronounced  in  the  second 
molar  than  in  the  third,  and  the  lesion  therefore  had  been  produced 
in  the  period  between  the  eruption  of  the  second  and  that  of  the  third 
molar.  Similarly,  the  permanent  teeth  of  young  subjects  at  Cro- 
Magnon,   Montrejeau,  and  La  Chaumiere  were  worn  before  the 

Ob*  rvations  relev£es  sur  quelques  momics  royales  d'figypte,"  Bull.  Soc. 
Anlhr,,  Paris,  IX  (18S6),  =178-90. 


288         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

eruption  of  the  third  molars,  and  the  cusps  of  the  deciduous  pre- 
molars of  Neolithic  people  from  Vendrest  in  the  Vendee  were  worn 
at  five  years  of  age,  the  lesion  being  very  pronounced  in  six-year-old 
children.  The  attrition  of  the  posterior  premolars,  affecting  the 
external  cusps  chiefly,  began  a  little  later  in  life.  In  ancient  Ger- 
many, also,  early  attrition  was  the  rule.  At  Adlerberg,  for  instance, 
the  molars  of  the  two  young  people  of  the  Bronze  Age  were  much 
worn,  although  the  third  molars  had  not  yet  emerged.  Among  the 
ancient  Nubians  and  Sudanese,  the  process  started  early  in  life  and 
the  rapidity  of  its  progress  could  be  estimated  approximately.  In 
several  mandibles  examined  by  one  at  Faras  and  Merawi,  in  which 
the  canines  were  just  showing  through,  the  first  lower  molars  were 
already  much  worn.  In  about  three  years,  therefore,  most  of  the 
mischief  had  been  done.  Similarly,  the  crown  of  the  second  pre- 
molar was  ground  down  very  deeply  in  the  interval  between  its 
eruption  and  that  of  the  third  molars.  Further,  the  lesions  may  be 
not  more  advanced  in  the  teeth  of  old  people  than  in  those  who  die 
young.  The  teeth  of  modern  Egyptians  are  sometimes  worn  to  the 
gums  before  the  age  of  twenty-five,  but  I  have  seen  Egyptians  more 
than  fifty  years  old  with  teeth  showing  little  trace  of  wear.  This 
may  be  due  to  the  character  of  the  food,  but  the  impression  gained 
from  the  examination  of  hundreds  of  skulls  is  that  attrition  in  these 
people  proceeded  very  rapidly  up  to  the  age  of  twenty-five  or  so, 
and  then  became  almost  completely  arrested.  This  is  not  in  accord 
with  observations  on  other  peoples. 

The  reason  for  the  severe  attrition  of  ancient  Egyptian  teeth 
was  doubtless  due  to  the  food.  The  Egyptians  were  nicknamed 
"eaters  of  bread,"  and  to  them  as  to  the  Hebrews,  bread  was 
synonymous  with  food.  It  was  made  from  spelt,  bearded  wheat, 
or  barley.  Cereals  were  cultivated  from  early  times,  though 
opinions  may  differ  as  to  which  at  different  periods  was  most  used 
for  breadmaking.  Flour  was  prepared  already  in  the  predynastic 
period  by  grinding  grain  between  two  stones  or  pounding  it  in  a 
mortar.  At  a  later  period  a  handmill,  and  later  still  a  mill  driven 
by  machinery  replaced  the  more  primitive  apparatus.  The  speci- 
mens of  old  Egyptian  bread  which  I  have  examined  consist  of  a 
very  coarse  paste  usually  containing  a  large  amount  of  husks  and 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        289 

some  straw  even,  together  with  coarse  fragments  of  unbroken  wheat 
or  barley  grain.  Undoubtedly  this  bread  did  not  improve  the 
masticating  surfaces,  even  if  it  did  contain  plenty  of  fibrous  material 
to  clean  the  interstices  of  the  teeth.  One  cannot  help  wondering 
whether  the  barley  and  wheat  were  cleaner  than  the  native  cereals 
contaminated  with  sand  and  earth  now  sold  in  Egyptian  markets; 
in  any  case,  the  pounding  in  a  mortar  or  the  grinding  between  stones 
necessarily  detached  many  fine  stone  particles,  which  mixed  with 
the  dough  escaped  detection,  but  which  chewed  every  day  certainly 
did  not  improve  the  crowns  of  the  teeth. 

The  contents  of  the  intestines  of  dried  predynastic  bodies  and 
of  mummies  from  dynastic  to  Coptic  periods,  prove  the  considerable 
quantity  of  coarse  vegetable  material — barley  husks  chiefly — that 
was  eaten,  and  this  observation  together  with  the  composition  of 
the  samples  of  bread  examined  by  the  writer  explains  the  attrition 
of  the  dental  crowns.  The  teeth  of  soldiers,  for  instance,  must  have 
been  severely  tried  by  their  daily  ration  of  four  pounds  of  bread. 

The  teeth  were  not  improved  by  the  mastication  of  the  roots  of 
marshy  plants,  which,  raw  or  cooked,  the  poorer  Egyptians — and 
possibly  the  richer — ate  in  large  quantities.  Indeed,  many  of  the 
children  of  the  poorer  class  were  brought  up  on  them.  The  chief  fruit 
eaten  by  the  Egyptian  consisted  of  grapes,  figs,  dates,  dates  from 
the  dum  palm,  pomegranates,  melons,  Balanites  Aegyptiaca,  Pali- 
urus,  carobs,  olives,  apricots  (?),  and  the  seeds  of  marshy  plants. 
With  the  exception  of  dates,  the  Paliurus,  and  the  seeds  of  aquatic 
plants,  the  fruit  eaten  had  but  little  or  no  effect  on  the  teeth,  for 
although  the  rich  had  extensive  fruit  gardens,  Egypt  has  never 
been  a  great  fruit-growing  country  and  the  Egyptians  of  the  poorer 
classes,  like  the  present  fellah,  probably  tasted  little  fruit  except 
dates  and  melons.  It  may  be  remarked  that  dates  are  not  infre- 
quently very  stringy. 

Attrition  was  intensified  by  the  consumption  of  raw  vegetables. 
Lentils,  beans,  artichokes,  asparagus,  beetroot,  and  cabbages  doubt- 
less were  cooked  before  being  served  up;  but,  on  the  other  hand, 
onions,  cucumbers,  garlic,  radishes,  turnips,  etc.,  were  eaten  raw 
with  bread,  as  is  done  now.  The  six  small  cucumbers  which  at  the 
proper  season  an  Egyptian  fellah  takes  for  his  breakfast,  make  fine 


290         STUDIES  IN  THE  PALAE0PATH0L0GY  OF  EGYPT 

exercise  for  his  masticating  apparatus  and  doubtless  provoke  a 
good  flow  of  saliva,  but  they  do  not  improve  the  crowns  of  his  teeth. 

The  diet  certainly  was  not  wholly  vegetarian,  for  the  predynastic 
refuse  heaps  of  El  Toukh  have  given  up  remnants  of  many  animals 
that  had  served  for  food.  Also,  cattle  were  kept  as  far  back  as 
Egyptian  civilization  can  be  traced,  and  many  wild  animals  and 
birds  were  either  hunted  or  kept  in  captivity  and  artificially  fat- 
tened. The  Nile  and  its  canals  were  inexhaustible  reservoirs  of 
fish;  salted  and  pickled  fish  was  a  favorite  article  of  food  and 
exported  to  foreign  countries.  It  would  have  been  interesting  to 
know  how  the  meat  was  cooked,  whether  it  was  eaten  well  done  or 
underdone,  and  whether,  in  fact,  it  helped  in  wearing  down  the 
teeth.  The  diet  sheets  which  have  come  down  to  us  point  to  a 
mixed  diet  having  been  the  rule  with  people  in  government  employ- 
ment and  with  the  better  class.  Under  Menhuhotep  III1  each 
soldier  of  an  expeditionary  corps  into  the  desert  received  two  jars 
of  water  and  twenty  small  biscuit-like  loaves.  In  the  XlXth 
Dynasty,  under  Seti  I,2  "His  Majesty  increased  that  which  was 
furnished  to  the  army  in  ointment,  ox-flesh,  fish,  and  plentiful 
vegetables  without  limit.  Every  man  among  them  had  four  debens 
[about  four  pounds]  of  bread  daily,  two  bundles  of  vegetables,  a 
roast  of  flesh,  and  two  linen  garments  monthly."  The  king's 
messengers  had  "good  bread,  ox-flesh,  wine,  sweet  oil,  fat,  honey, 
figs,  fish,  and  vegetables  every  day." 

At  Silsileh,3  every  one  of  the  thousand  workmen  employed  in 
the  sandstone  quarries  received  daily  nearly  four  pounds  of  bread, 
two  bundles  of  vegetables,  and  a  roast  of  meat.  The  king's  body- 
guard4 was  given  in  addition  "  to  each  five  minae  in  weight  of  baked 
bread,  two  minae  of  beef,  and  four  arysters  of  wine." 

The  following  inscription  copied  from  the  tomb  of  Beha  in  the 
XVIIIth  Dynasty5  refers  to  the  diet  of  children:    "The  children 

were — great    and    small — sixty They    all    consumed    120 

ephahs  of  durra,  the  milk  of  3  cows,  52  goats,  and  9  she-asses,  a  hin 
of  balsam,  and  2  jars  of  oil."     According  to  this,  bread  of  durra, 

1  Hammamat  inscriptions  of  Henu.         3  Breasted,  History  of  Egypt,  p.  414. 

2  Assuan  inscription.  *  Herodotus  ii.  163. 
s  Brugsch,  Egypt  under  the  Pharaohs,  p.  121. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH         291 

milk,  and  oil  were  the  children's  diet.  The  children  of  well-to-do 
people  who  went  to  school  carried  their  daily  food,  bread,  and  oil 
with  them,  but  the  poorer  people's  children  were  not  so  spoilt: 
"They  give1  them  very  simple  cooked  foods  which  can  be  grilled 
before  the  fire,  roots,  and  roots  of  plants  growing  in  marshes,  some- 
times raw  and  sometimes  roasted."  The  Alexandrians,  of  course,  ate 
the  native  dishes  and  all  the  luxurious  dishes  of  Rome  and  Greece. 
The  attrition  of  the  Egyptian  teeth,  the  contents  of  the  refuse 
heaps,  the  intestinal  contents,  the  offerings  of  food  in  tombs,  the 
mural  decorations,  and  the  literary  evidence,  all  point  to  a  mixed 
diet,  of  which  coarse  bread  and  vegetables  formed  the  chief  con- 
stituents. To  explain  the  attrition  it  is  not  necessary  to  assume, 
as  has  been  done,  that  the  Egyptians  ate  earth  or  that  the  food  was 
contaminated  with  sand. 

IV.      CARIES 

Carious  human  teeth  from  ancient  remains  have  been  discovered 
in  so  many  places  that  it  is  legitimate  to  doubt  whether  there  was 
ever  an  epoch  when  the  human  species  was  not  cursed  by  toothache. 

The  population  of  England  has  certainly  suffered  from  it  for 
thousands  of  years.  Of  69  skulls  from  Wiltshire  tumuli,2  dating 
from  the  Stone  Age,  2  had  carious  teeth.  The  people  buried  in  the 
tumuli,  a  pastoral  and  agricultural  race,  lived  by  the  chase  and 
"their  habits  were  barbarous."  Nine  cases  of  caries,  namely  4  on 
occluding  and  5  on  approximal  surfaces,  were  found  in  44  skulls  of 
a  similar  group  inhabiting  more  northern  districts  of  England.  In 
the  people  of  a  later  race  (Bronze  period),  the  agricultural  popula- 
tion referred  to  by  Caesar  in  his  Commentaries,  there  were  6  cases 
of  caries  in  32  skulls,  5  on  approximal  and  1  on  occluding  surfaces. 
The  teeth  of  Romans  in  England  were  not  infrequently  carious; 
of  143  skulls,  about  32  showed  signs  of  caries,  and  in  one  instance 
the  disease  was  extensive.  In  76  skulls  of  the  Anglo-Saxon  period, 
caries  was  present  in  15. 

The  painful  ailment  was  common  in  the  inhabitants  of  ancient 
France.  At  least  two  skulls  from  Aurignac,3  several  crania  of  the 
Furfooz,  La  Truchere,  and  Aurignac  races,"  a  skull  from  the  cavern 

1  Diodorus  Siculus  i.  93.  ■>  Quatrefage  et  Hamy,  op.  ciL,  p.  104. 

'  J.  R.  Mummery,  loc.  cit.  «  Ibid. 


292         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

of  Engilhoul,1  a  prehistoric  skull  from  the  Carriere  Helie  at  Gre- 
noble,2 skulls  from  dolmens  (Billancourt,  Moulin-Quignon),3  all 
these  had  carious  teeth,  sometimes  associated  with  extensive  lesions. 

It  is  estimated,  but  on  what  appears  to  me  insufficient  data, 
that  only  about  i .  5  per  cent  of  the  people  found  in  the  Neolithic 
ossarium  of  Bagoges-en-Pareds  had  carious  teeth.  At  Vendrest,  in 
the  Vendee,  of  1,948  teeth  collected  in  a  Neolithic  ossarium,  49 
molars  and  n  premolars  were  carious,  but  no  incisors  or  canines. 
The  dental  pulp  of  36  was  attacked;  in  25  there  was  slight  caries  of 
the  neck  only;  and  in  1  the  caries  was  limited  to  the  masticating 
surface  of  a  wisdom  tooth.  Of  3 1 7  deciduous  teeth,  2  molars  showed 
slight  caries  in  the  neighborhood  of  the  neck.  From  these  observa- 
tions the  conclusion  was  drawn  that  caries  was  neither  common  nor 
severe  in  that  period.  A  Neolithic  burial4  contained  a  carious 
tooth  pierced  for  suspension. 

Carious  teeth  have  been  discovered  in  the  grotto  of  Mayrannes 
(Bronze  Age),5  in  dolmens  of  the  Gard,  of  Saint- Vallier  de  Thoy 
(Reviere),  in  the  grottos  of  Albaree  (Alpes  Maritimes),  in  the  grotto 
of  La  Marthe,  and  at  Carzy-la-Rouet.  The  Roman  settlers  in 
Gaul  suffered,  for  the  right  upper  second  premolar  and  second  molar 
of  a  Roman  skull  were  carious,  and  the  left  lower  second  premolar 
and  all  the  molars  had  been  shed  prematurely. 

Caries  worried  the  ancient  Germans  also.  A  skull  from  the  6th 
to  10th  century  B.C.,  unearthed  at  Reiherwerder,  had  4  carious  teeth 
out  of  the  5  remaining;  and  the  disease  had  probably  been  exten- 
sive, for  the  absorption  of  the  alveoli  proved  that  the  missing  teeth 
had  been  lost  during  life.  Other  examples  were  discovered  in  the 
Ruhr  Valley,  where  several  teeth  from  32 — or  possibly  34 — cavern 
burials6  were  carious.     Human  teeth  dating  from  the  La  Tene 

1  E.  T.  Hamy,  "Note  sur  les  ossements  humains  fossiles  de  la  seconde  caverne 
d'Engilhoul  pres  Liege,"  BttU.  Soc.  Anthr.,  Paris,  VI  (1871),  370-86. 

2  Quatrefages  et  Hamy,  op.  oil.,  p.  20. 

3  Ibid.,  Pl.XCVII-3,  p.  112. 

4  Camus,  L'homme  prehistorique,  VI  (1908),  326. 

s  Ch.  Cotta,  "La  carie  dentaire  et  l'alimentation  dans  la  Provence  prehistorique," 
L'homme  prehistorique,  III  (1905),  74. 

6  Carthaus,  "Uber  die  Ausgrabungen  in  der  Valedahohle  unweit  Velmede  im 
oberen  Ruhrtale,"  Prahist.  Zeitschr.,  Ill  (1911),  137. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH         293 

period  from  Zeiningen1  and  Worms  am  Rhein,2  showed  similar 
changes.  Ancient  Denmark,3  Sweden,  Norway,  and  Italy4  were 
certainly  not  free  from  the  disease. 

From  the  earliest  to  the  present  times,  caries  had  attacked 
human  teeth  in  Nubia,  Upper  and  Lower  Egypt,  and  yet,  from  the 
data  at  our  command,  it  is  almost  impossible  to  form  an  opinion 
regarding  the  incidence  of  the  ailment  during  successive  centuries. 
One  observer  whose  opinion  certainly  carries  great  weight  expresses 
himself  as  follows:5 

Both  in  Nubia  and  Egypt  the  ordinary  form  of  caries  is  exceedingly  rare 
in  predynastic  and  protodynastic  people,  and  among  the  poorer  classes  it  never 
became  at  all  common  until  modern  times Dental  caries  became  com- 
mon as  soon  as  people  learned  luxury.  In  the  cemetery  of  the  time  of  the 
Ancient  Empire,  excavated  by  the  Hearst  expedition  at  the  Giza  pyramids, 
more  than  five  hundred  skeletons  of  aristocrats  of  the  time  of  the  pyramid- 
builders  were  brought  to  light,  and  in  these  bodies  I  found  that  tartar  forma- 
tion, dental  caries,  and  alveolar  abscesses  were  at  least  as  common  as  they  are 
in  modern  Europe  today.  And  at  every  subsequent  period  of  Egyptian  history 
one  finds  the  same  thing — the  wide  prevalence  of  every  form  of  dental  disease 
among  the  wealthy  people  of  luxurious  diet,  and  the  relative  immunity  from 
it  among  the  poorer  people  who  lived  mainly  on  a  coarse,  uncooked  diet. 

Among  the  Biga  people  of  Nubia  in  whom  dental  caries  appeared  to  be 
very  prevalent,  everything  points  to  the  fact  that  the  people  buried  at  Biga 
were  not  leading  the  life  of  their  neighbours.  The  abundance  of  clothes  and 
the  number  of  wine-jars  suggest  a  life  of  luxury — and  gout  is  not  engendered 
by  the  ordinary  fare  of  Nubia.  This  all  means  that  dental  caries  in  the  early 
Christians  of  Biga  was  due  to  the  operation  of  the  same  factors  which  are 
supposed  to  be  causally  related  to  it  elsewhere,  namely,  an  improper  diet. 
This  conclusion  is  borne  out  by  the  extreme  rarity  of  dental  caries  in  children 
throughout  these  Egyptian  and  Nubian  cemeteries,  because  they  lived  on  the 
food  supplied  by  nature  and  not  that  provided  by  the  chemist. 

That  the  frequency  of  caries  in  Nubia  and  Egypt  increased 
gradually  from  predynastic  to  Christian  times  and  later  is  undoubt- 
edly the  first  impression  produced  by  the  examination  of  ancient 

'Holder,  "Untersuchungen  iiber  die  Skelettfunde  in  den  vorromischen  Hiigel- 
grabcrn  Wiirttembergs  und  Hohenzollerns,  F undbcrichlc  aus  Schwabcn,  II  (189s). 

1  P.  Bartels,  "Uber  Schiidel  und  Skelettreste  der  friiheren  Bronzezeit  aus  der 
Umgebung  von  Worms  am  Rhein,"  PrShist.  Zcitschr.,  IV  (1912). 

1  II.  A.  Nielsen,  Danemark  Arch.  f.  Gesch.  d.  Med.,  IV,  377. 
ll  refages  et  Hamy,  op.  til.,  PI.  XCI,  Fig.  3. 

» Elliot  Smith,  A.S.  A\,  II.,  281. 


294         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Egyptian  skulls,  and  yet  no  observer  has  brought  forward  any 
satisfactory  statistical  evidence  to  support  it.  An  estimation  of  the 
incidence  of  caries  in  any  given  community  based  on  the  examina- 
tion of  skulls  is  very  difficult  always,  and  not  infrequently  well-nigh 
impossible.  Many  teeth  invariably  disappear  during  excavations, 
and  there  is  every  reason  to  suppose  that  some  of  these  teeth  were 
carious,  although  they  never  figure  as  such  in  statistics.  The 
incidence  of  caries,  therefore,  is  always  estimated  too  low. 

An  attempt  was  made  to  estimate  the  number  of  cases  of  caries 
in  the  large  collection  of  skulls  in  the  Museum  of  the  Medical  School 
of  Cairo,  which  contained  a  large  number  of  predynastic  skulls, 
others  dating  from  the  IVth  to  the  Xllth  Dynasties,  others  again 
from  the  time  of  the  pyramid-builders  at  Gizeh,  and  from  Ptolemaic 
and  Coptic  times.  The  result  was  worth  nothing;  firstly,  because 
it  was  impossible  to  diagnose  why  a  missing  tooth  had  been  lost 
during  life,  and  secondly  on  account  of  the  enormous  number  of 
teeth  which  had  fallen  out  after  death.  In  the  case  of  the  skulls 
from  Gizeh  and  the  dynastic  skulls,  not  even  an  approximate  idea 
regarding  the  incidence  of  caries  could  be  formed. 

The  field  notes  on  cemeteries  in  Nubia  prove  that  the  disease 
existed  in  predynastic  times,  and  among  the  archaic  Nubians. 
Some  of  the  lesions  connected  with  caries  in  Nubians  from  the 
middle  of  the  Ancient  Empire  were  very  severe.  The  skull  of  an 
old  man,  for  instance,  had  extremely  carious  teeth,  with  alveolar 
abscesses  at  the  roots  of  eight  upper  and  eight  lower  teeth.1  In 
other  skulls  of  the  same  epoch,  caries  was  limited  to  one  or  two 
teeth. 

No  less  severe  were  occasionally  the  lesions  in  more  modern 
times,  in  the  later  B  group,  for  instance.2  The  front  teeth  of  a  man 
from  this  period  were  much  worn,  the  stumps  of  the  upper  teeth 
and  upper  right  second  premolar  were  carious,  and  all  the  lower 
teeth  behind  the  premolars  had  been  lost  during  life,  with  the  excep- 
tion of  the  carious  stumps  of  the  right  molars.  A  Nubian  woman 
from  the  Middle  Empire,  with  teeth  very  much  worn  and  carious, 
had  extensive  inflammation  of  the  left  mandible  spreading  from  the 
alveoli.     During  the  Roman,  Christian,  and  Byzantine  periods  in 

1  A.  S.  N.,  p.  75.  2  Ibid.,  p.  11S. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        295 

Nubia  the  disease  was  active  and  the  coexistent  lesions  sometimes 
very  severe.  The  skull  of  a  middle-aged  Christian  woman1  was 
disfigured  by  a  dental  abscess  round  the  roots  of  the  right  upper 
second  premolar  and  of  the  first  molar,  which  opened  on  the  palate 
and  the  face,  and  there  were  also  small  abscesses  round  other  carious 
teeth.  A  very  old  woman2  had  lost  all  her  teeth  except  one  carious 
upper  stump  and  four  similar  fragments  in  the  lower  jaw.  Other 
skulls  had  evidently  lost  most  of  their  teeth  from  the  disease,  as 
several  of  the  remaining  teeth  were  carious. 

The  teeth  of  prehistoric  skulls  from  Naga  el  Deir  in  Egypt  were 
not  infrequently  carious,  but,  as  a  rule,  there  were  not  more  than 
two  or  at  most  three  carious  teeth  in  any  one  skull  or  mandible. 
Lesions  secondary  to  caries  were  usually  absent,  and  in  one  case 
only  was  secondary  disease  of  the  maxilla  noted. 

I  attempted  td  tabulate  the  cases  of  dental  disease  in  Nubia 
according  to  the  notes  of  the  Archaeological  Survey,  and  the  table 
so  prepared  certainly  showed  a  rise  in  the  number  of  cases  of  caries 
and  dental  disease  after  Ptolemaic  times.  Of  72  skulls  of  the  B 
group,  for  instance,  20  per  cent  had  lost  some  teeth  and  four  had 
carious  teeth,  whereas  of  165  skulls  dating  from  a  time  after  the 
Ptolemaic  period  74  per  cent  had  missing  and  28  per  cent  had 
carious  teeth.  At  first  sight  only  one  conclusion  appears  possible, 
namely,  that  dental  disease  and  especially  caries  increased  in  fre- 
quency in  the  two  thousand  odd  years  between  the  B  group  and 
the  beginning  of  the  Christian  era. 

On  examining  the  notes  more  closely,  however,  the  incidence  of 
dental  disease  and  caries  was  found  to  have  remained  practically 
stationary  for  a  long  period  and  then  to  have  risen  suddenly  to  an 
unprecedented  level  after  Ptolemaic  times.  When  seeking  an  expla- 
nation for  this  startling  fact  one  was  led  to  wonder,  as  Wood  Jones 
had  done,  whether  this  extraordinary  rise  was  not  due  to  any 
immigration  of  people  who  accommodated  themselves  badly  to 
their  new  conditions  of  life  and  their  new  food. 

The  facts  are  as  follows:  The  predynastic  and  the  A  group  of 
dynastic  people  in  Nubia  were  the  old  Egyptian  race  with  little 
admixture  of  negro.     The  percentage  of  black  blood  increased 

'  Ibid.,  p.  42.  3  Ibid.,  p.  52. 


296         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

slightly  in  the  people  of  the  B  period  and  still  more  in  the  C  group. 
The  New  Empire  saw  a  considerable  influx  of  Egyptians  until, 
later  on,1  the  Nubian  element  again  increased.  Groups  of  negroid 
people  then  began  to  make  their  appearance  (Group  E).  These 
have  been  met  with  in  Ptolemaic  and  even  in  some  Roman  ceme- 
teries of  Nubia,  and  some  possibly  emigrated  or  were  brought 
as  slaves  into  Egypt.  The  race  inhabiting  Nubia,  therefore,  was 
fairly  pure  at  first,  but  gradually  became  more  and  more  mixed. 
The  intermixture  increased  still  more  after  the  Ptolemaic  period, 
especially  among  the  Biga  people  who,  as  had  been  noted,  suffered 
much  from  dental  disease,  as  43  out  of  86  skulls  had  missing  teeth 
and  16  had  caries.  Most  of  the  Biga  people,  among  whom  the 
incidence  of  caries  was  highest,  were  immigrants,  perhaps  from 
Asia  Minor,  who  intermarried  with  Nubian  women  together  with  a 
few  Egyptians  and  many  Sudanese.  It  is  considered  probable  that 
at  the  time  of  their  deaths  these  immigrants  had  not  been  settled 
in  the  neighborhood  for  more  than  thirty-five  to  forty  years.  A 
comparison  between  a  race  of  immigrants  and  dynastic  or  pre- 
dynastic  Nubians  must  lead  to  fallacious  conclusions  because  the 
age,  habits,  and  perhaps  the  cookery  of  the  two  classes  of  people 
were  probably  very  different. 

It  is  not  necessary  to  assume  that  the  increase  in  caries  and 
dental  disease  among  the  Biga  people  was  the  just  punishment  for 
a  more  luxurious  mode  of  living.  The  food,  to  judge  from  the 
attrition  of  the  teeth  which  is  noted  in  several  observations,  was 
fairly  coarse,  for  attrition  is  not  the  characteristic  result  of  soft  food, 
the  alleged  cause  of  caries.  Those  people  probably  drank  wine,  but 
wine  was  used  in  Egypt  and  Nubia  from  the  earliest  times,  vine- 
yards existed  in  both  countries,  and  Nubian  beer  had  a  great  name 
long  before  the  Christian  epoch,  indeed,  it  is  mentioned  in  so  ancient 
a  book  as  the  Liturgy  of  Funerary  Offerings.  Neither  is  the  fact 
that  one  case  of  gout  was  discovered  a  proof  of  luxurious  living. 
There  is  such  a  thing  as  poor  man's  gout.  Uric-acid  calculi  have 
been  taken  from  Egyptian  bodies  dating  from  the  Hid  Dynasty 
and  possibly  earlier  times,  and  indeed  occur  among  herbivorous 
animals.     When  these  foreign  immigrants  were  excluded,  the  inci- 

*A.  S.N.,p.  36. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH         297 

dence  of  dental  disease  was  seen  to  vary  considerably  in  different 
cemeteries  during  Ptolemaic  and  Christian  times. 

The  author's  study  of  the  predynastic  skulls  in  Egypt  showed 
that  caries  and  dental  disease  were  present  from  very  early  times 
The  results  of  the  examination  of  these  skulls  are  as  follows :  Maxil- 
lae: Out  of  156  specimens,  the  number  with  missing  or  carious  teeth 
was  54,  or  35  per  cent;  the  number  with  carious  teeth,  32,  or  20 
per  cent.  Mandibles:  95  specimens;  number  with  missing  or 
carious  teeth,  21,  or  20  per  cent;  number  with  carious  teeth,  15,  or 
1 5  per  cent.  A  little  less  than  one-half  of  the  maxillae  of  prehistoric 
Egyptians  and  four-fifths  of  the  mandibles  had  not  lost  any  teeth 
and  showed  no  decay,  which  is  a  remarkably  good  record. 

These  figures  taken  by  themselves,  however,  would  give  a  wrong 
impression  regarding  the  prevalence  of  the  dental  disease  in  pre- 
dynastic times,  for  60  per  cent  at  least  of  all  maxillae  and  mandibles 
were  scarred  with  lesions  of  chronic  suppurative  periodontitis. 
Forty-five  skulls  had  abscesses  connected  with  the  maxillary  teeth, 
of  which  12  were  associated  with  caries,  10  with  missing  teeth,  5 
with  both  defects,  and  in  28  skulls  with  abscesses  no  teeth  were 
missing  and  there  was  no  caries.  Eighty-two  upper  jaws  out  of 
156,  or  53  per  cent,  therefore,  had  gross  pathological  lesions  of  or 
connected  with  the  teeth.  Of  the  95  mandibles,  12  had  dental 
abscesses.  These  abscesses  were  associated  with  missing  teeth  in 
two  cases,  and  with  carious  teeth  in  two  others.  Twenty-nine  per 
cent,  therefore,  showed  gross  lesions  of  dental  disease.1 

The  following  data  give  the  incidence  of  carious  and  missing 
teeth  according  to  their  position: 

Upper:    M  1,  M  3,  M  2,  I,  Pm  2,  Pm  1,  C,  I  2; 
Lower:    M  2,  M  3,  M  1,  Pm  2,  Pm  1,  I,  I2  C. 

These  figures  prove  clearly  that  the  molars,  the  first  molars 
especially,  were  in  the  old  Egyptians  the  teeth  most  prone  to  caries, 
and  this  observation  agrees  with  the  results  of  modern  statistics 
regarding  the  incidence  of  caries  in  individual  teeth,  statistics 
nearly  always  derived  from  records  of  extractions. 

'  The  cases  of  chronic  suppurative  periodontitis  without  abscesses  are  not  counted. 


298         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Statistics  from  Vienna  based  on  examination,  and  not  on  extrac- 
tions, do  not  give  the  same  results,  and  according  to  them  the  liabil- 
ity of  individual  maxillary  teeth  to  caries  stands  in  the  following 
order : 

1. 1,  M  1,  I  2,  Pm  1,  M  2,  Pm  2,  C,  M  3; 

and  in  the  mandible: 

M  1,  M  2,  Pm  2,  Pm  1,  M  3,  C,  I  2, 1  1. 

On  the  whole,  our  data  correspond  fairly  well  with  the  statistics 
that  have  been  based  on  the  extraction  of  teeth,  which  are: 

Maxillary:    M  1,  M  3,  M  2,  I  1,  Pm  2,  Pm  2,  Pm  1,  C,  I  2; 
Mandible:    M  2,  M  3,  M  1,  Pm  2,  Pm  1,  I  2,  C,  and  I  1. 

The  following  were  the  results  obtained  by  the  author's  examina- 
tion of  skulls  in  the  predynastic  to  1st  Dynasty  cemeteries  of 
Tourah  near  Cairo  :" 

Of  29  skulls  3  belonged  to  children  not  more  than  sixteen  years 
of  age.  Seven  of  the  remaining  skulls  were  more  or  less  broken 
and  parts  of  the  dentition  were  missing;  in  2  others  some  teeth 
were  broken  away  in  the  first  specimen  and  the  teeth  had  dropped 
out  after  death  in  the  second.  There  was  no  caries  in  any  skull: 
a  very  striking  fact,  for,  even  making  allowances  for  the  number  of 
skulls  more  or  less  damaged,  and  for  the  youth  of  many  of  the  cases, 
a  series  of  17  skulls  free  from  caries  could  not  easily  be  discovered 
anywhere  in  collections  of  modern  skulls.  On  the  other  hand, 
lesions  of  periodontal  disease,  abscesses,  loosening  of  teeth,  etc., 
were  present  in  10  of  the  complete  skulls  and  1  skull  had  lost  many 
teeth  post  mortem. 

Caries  was  present  also  in  some  of  the  predynastic  skulls  at 
Dahshur,2  and  in  one  of  them  the  only  remains  of  the  teeth  consisted 
of  a  few  worn  and  carious  stumps.  In  the  same  locality3  the  prin- 
cess Nourhotep,  who  was  about  forty-five  years  old  at  the  time  of 
her  death,  had  two  carious  first  molars,  and  the  alveoli  of  these 
were  inflamed. 

1  D.  E.  Derry,  in  Hermann  Junker,  "  Bericht  iiber  die  Grabungen  auf  dem  Friedhof 
in  Turah,"  Denkschr.  Ac.  Wiss.,  Wien,  LVI  (1912). 

2  De  Morgan,  Les  origincs  dc  VEgyptc,   p.  280.  3  Ibid.,  p.  148. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        299 

An  examination  of  skulls  from  the  XXV th  to  XXVIth  Dynasties 
at  Merawi,  in  the  Sudan,  and  of  crania  dating  from  the  Meroitic 
kingdom  of  Faras,  revealed  the  presence  of  caries  in  1 2  per  cent  of 
the  skulls  only.  Owing  to  the  pressure  of  time,  however,  the 
examination  at  the  graveside  was  rather  superficial,  and  the  crowns 
of  a  large  number  of  teeth  had  been  broken  off,  while  numerous 
teeth  had  been  lost  after  death.  Of  the  36  skulls  and  fragments  of 
mandibles  from  Faras  and  Merawi  which  were  taken  to  Alexandria 
for  examination  all  but  2  had  one  or  more  carious  teeth.  The 
crowns,  as  a  rule,  were  not  affected,  the  carious  hole  being  in  the 
neck  of  the  tooth. 

Of  no  ancient  though  not  accurately  dated  skulls  from  Thebes,1 
12  only  had  carious  teeth,  and  in  2  cases  only  a  very  small  part  of 
the  tooth  was  affected.  It  must  be  noted,  however,  that  many  of 
these  skulls  also  had  lost  a  number  of  teeth  during  life,  of  which 
some  may  have  been  carious. 

Several  aristocrats,  whose  mummies  are  now  in  the  Cairo 
Museum,  were  martyrs  to  caries  during  life.  All  the  maxillary 
teeth  of  a  woman,  for  instance  (Princess  Maritamon,  Xllth-XIIIth 
Dynasties,  about  1900  B.C.),  were  carious  with  the  exception  of  the 
canine  and  the  third  molar,  and  the  first  and  second  molars  were 
reduced  to  mere  stumps.  An  aged  court  lady  (XVIIIth  Dynasty, 
about  1400  B.C.)  had  a  carious  upper  first  molar,  and  alveolar 
abscesses  at  the  root  of  the  neighboring  molar. 

Nineteen  hundred  years  ago,  caries  also  was  by  no  means  rare  in 
the  Egyptian  population  of  Alexandria,  and  it  attacked  children  and 
young  adults  also.  A  child  with  complete  deciduous  dentition  had 
deep  caries  of  the  first  upper  right  molar  and  neighboring  premolar, 
the  crowns  of  these  teeth  being  completely  destroyed,  and  traces  of 
suppuration  were  to  be  seen  round  the  maxillary  molars  on  both 
sides.  A  young  adult,  with  wisdom  teeth  still  unerupted,  showed 
caries  of  both  first  upper  molars  on  the  approximal  side.  The  right 
second  upper  molar  of  another  young  woman  was  so  deeply  carious 
that  the  whole  had  disappeared. 

Some  cases  of  caries  in  adults  were  very  severe.  A  male,  for 
instance,  between  forty  and  fifty  years  old,  had  lost  the  left  upper 

'  Hermann  Stahr,  Die  Rassenfragc  im  antiken  Agyplen. 


300         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

first  molar  and  neighboring  premolar  during  life,  the  alveolus  of  the 
latter  showing  an  external  fistulous  opening  about  2  mm.  wide.  The 
dental  canal  of  the  right  second  upper  premolar  had  been  opened 
by  attrition,  as  the  right  first  upper  molar  was  also  carious  on  its 
approximal  side.  Both  teeth  were  covered  with  thick  tartar,  and, 
the  buccal  border  having  been  completely  absorbed,  both  alveoli 
communicated  with  the  mouth  by  a  wide  aperture.  Attrition, 
caries,  and  rarefying  periostitis  had  all  helped  to  produce  these 
lesions. 

The  Copts  of  Antinoe"  must  often  had  suffered  acutely  from 
toothache,  as  may  be  seen  from  the  following  notes  on  the  teeth  of 
these  people : 

1.  Adult  man,  probably  about  forty-five  years  old,  had  lost  the  right  first 
upper  molar  and  second  premolar,  together  with  the  left  first  upper  molar. 
In  the  mandible  the  right  second  premolar  and  first  molar  together  with  the 
left  molar  had  been  shed  during  life.  The  left  lower  second  premolar  was 
carious  on  distal  side. 

2.  Adult  woman,  probably  about  twenty-six  years  old.  The  lower  third 
molars  were  present,  whereas  the  corresponding  upper  teeth  had  not  emerged. 
The  right  lower  first  molars  and  left  molars  and  premolars  were  shed  during 
life.  There  was  extensive  caries  of  the  posterior  part  of  the  left  lower  second 
molar  extending  almost  to  the  fang,  and  of  the  right  second  and  third  molars 
at  the  point  of  contact.     The  crowns  showed  but  slight  attrition. 

3.  Man,  adult,  but  not  aged,  probably  about  thirty  years  old.  Teeth 
missing — upper,  all  right  premolars  and  molars,  left  second  premolar  and  third 
molars;  lower — right  second  molar,  left  molars  and  premolars.  Second  right 
upper  incisor  carious;  region  occupied  by  left  first  and  second  upper  molars 
hollowed  out  into  a  cavity  with  deeply  pitted  floor,  measuring  15  mm.  from 
before  backwards  and  12  mm.  from  side  to  side;  outer  wall  of  the  alveolus  of 
the  first  molar  completely  gone. 

Very  startling  is  the  statement1  that  in  Nubia  caries  was  not 
met  with  in  the  deciduous  teeth  of  children  of  the  archaic  period — 
that  it  did  not  make  its  appearance  until  the  Christian  era,  and  that, 
even  in  Christian  children,  the  disease  was  very  rarely  seen.  The 
observation,  though  interesting,  does  not  justify  the  conclusions 
which  have  been  based  on  it.  In  the  first  place,  many  of  the  infan- 
tile skulls  that  have  been  discovered  were  those  of  newly  born  chil- 
dren or  babies,  in  whom  for  obvious  reasons  caries  could  not  have 

'  A.S.N. ,  p.  279. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        301 

occurred,  and  in  Egypt  as  in  Nubia  the  number  of  children's 
skeletons  which  have  been  studied  is  so  small  as  to  be,  in  my  opinion, 
almost  useless  for  forming  an  estimate  regarding  the  incidence  of 
infantile  caries,  or  of  any  other  infantile  disease.  In  Nubian 
adolescents  and  adults  extensive  lesions,  directly  or  indirectly  due 
to  caries,  were  not  rare,  especially  in  Christian  times.  A  Coptic 
boy  of  Nubia,1  seventeen  years  old,  had  a  large  abscess  cavity  at 
the  root  of  the  right  upper  second  molar  on  the  outer  side;  the  right 
second  lower  bicuspid  also  was  carious,  and  the  right  and  second 
molars  together  with  their  alveoli  had  disappeared;  the  left  second 
lower  molar  was  represented  by  a  carious  stump  only.  A  young 
woman  from  the  Roman  period  had  worn  and  carious  teeth.  A 
young  Christian  woman  had  lost  seven  teeth  during  life,  and  the 
right  upper  second  incisors  together  with  the  right  lower  second 
premolar  were  carious;  another  young  Christian  woman  had  caries 
of  several  upper  teeth;  and  several  more  young  early  Christians 
suffered  extensively  from  caries. 

The  teeth  of  the  Macedonian  soldiers  buried  at  Chatby  were 
not  often  attacked  with  caries  and  in  no  case  was  this  found  to 
have  been  very  severe.  Here  also,  however,  the  same  difficulty 
presented  itself  in  estimating  the  exact  percentage  of  dental  disease, 
owing  to  the  fact  that  many  of  the  teeth  had  dropped  out  after 
death  and  could  not  be  found,  and  therefore  only  the  teeth  of  which 
the  alveoli  showed  partial  or  complete  absorption  were  considered 
as  having  been  lost  through  disease. 

V.      OTHER   LESIONS 

Alveolar  and  perialveolar  abscesses  have  been  frequently  ob- 
served in  ancient  skulls  in  England,  Germany,  and  France,  and  have 
been  usually  attributed  to  infection  through  dental  canals  opened 
by  attrition.  In  England,  for  instance,  many  teeth  of  a  skeleton 
from  Hailing  (Kent),  dating  from  late  Palaeolithic  or  early  Neolithic 
times,  had  been  lost  apparently  through  exposure  of  the  pulp 
cavities,  which  had  led  to  the  formation  of  abscesses  at  the  roots.2 
At  Zairingen  in  Germany,  a  skull  from  the  grotto  of  Ale  had  an 
abscess,  apparently  due  to  the  opening  up  by  attrition  of  the  dental 

'  Ibid.,  p.  48.  2  A.  Keith,  Jour.  Anlhr.  Inst.,  XLIV  (1914)- 


302         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

pulp  of  the  left  upper  third  molar.  Many  similar  cases  have  been 
discovered  in  French  ossaria — in  the  Vendee,  for  instance — and  in 
Denmark,  Sweden,  Norway,  Australia,  and  elsewhere. 

Dental  abscesses  were  common  in  every  cemetery  of  Nubia  and 
Egypt.  An  ancient  Nubian,1  for  instance,  had  several  alveolar 
abscesses  supposed  to  have  resulted  from  infection  through  pulp 
cavities  opened  by  attrition,  and  most  of  the  upper  as  well  as  lower 
teeth  had  been  lost.  Another  predynastic  man2  had  only  a  few 
teeth  left  which  were  greatly  worn  and  had  abscess  cavities  at  their 
roots;  the  right  side  of  his  face  showed  "abundant  inflammatory 
disease"  probably  connected  with  the  teeth.  Again,  well-worn 
teeth  with  five  abscesses  at  their  roots  were  found  in  an  archaic 
Nubian3  who  died  some  time  between  the  ages  of  twenty-five  and 
forty;  a  young  Christian  woman4  also  had  an  abscess  at  the  roots 
of  the  left  upper  third  molar,  and  the  pus  had  perforated  into  the 
antrum. 

Of  ioo  maxillary  abscesses  in  predynastic  people,  22  were  round 
the  first  molars ;  1 7  were  round  the  second  molars ;  1 5  were  round 
the  median  incisor;  n  were  round  the  posterior  premolars;  10 
were  round  the  anterior  premolars;  9  were  round  the  canines;  9 
round  the  third  molars;  6  round  the  lateral  incisors;  and  the 
position  of  1  was  doubtful. 

Of  35  mandibular  abscesses  in  the  same  people,  13  were  round 
the  first  molars;  6  were  round  the  canines;  5  were  round  the  second 
molars;  4  were  round  the  median  incisors;  3  were  round  the 
posterior  premolars;  3  were  round  the  third  molars;  and  1  was 
round  the  anterior  premolars. 

The  abscesses  were  often  multiple.  Thus  the  jaw  of  a  Nubian 
female  was  riddled  with  dental  abscesses,  and  in  another  such 
purulent  collections  had  developed  round  the  second  and  third 
molars  on  both  sides. 

In  Egypt,  numerous  dental  abscesses  have  been  found  in  Theban 
skulls  from  various  periods.  At  Tourah,5  on  the  northern  borders 
of  Lower  Egypt,  single  or  multiple  abscesses,  due  either  to  exposure 

M.S.  A\,  p.  117. 

2  Ibid.,  p.  127.  4  Ibid. 

3  Ibid.  s  Derry,  loc.  cit. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        303 

of  the  pulp  cavity  through  attrition  or  to  alveolar  inflammation, 
were  met  with,  both  in  predynastic  and  dynastic  skeletons. 

A  very  remarkable  case  of  possible  infection  through  such  an 
abscess  has  been  put  on  record.  An  old  woman  from  the  Hid 
Dynasty  cemetery  at  Tourah  had  upper  teeth  worn  down  to  stumps 
and  on  each  side  a  huge  hole  near  the  site  of  the  first  molar,  com- 
municating with  the  antrum.  All  the  molars  and  most  of  the  other 
teeth  were  gone  and  their  alveoli  absorbed,  leaving  behind  traces 
of  the  former  presence  of  alveolar  abscesses.  The  lower  teeth  were 
much  worn,  and  an  alveolar  abscess  had  formed  at  the  root  of  the 
left  first  molar.  The  right  first  molar  communicated  with  a  huge 
hole  on  the  right  side  of  the  mandible,  and  a  necrotic  process  attack- 
ing this  bone  had  eaten  away  almost  the  whole  of  the  right  half  of 
the  lower  jaw,  the  disease  extending  along  the  bone  and  across  the 
symphysis  nearly  to  the  left  canine  tooth.  The  hole  in  the  man- 
dible was  oval,  6  mm.  in  length,  commenced  at  the  junction  of  the 
right  ramus  with  the  body,  and  the  bare  roots  of  the  teeth  protruded 
through  the  roof  of  the  immense  abscess  cavity.  In  the  pelvis,  an 
apparently  similar  necrosis  had  destroyed  practically  the  whole  of 
the  iliac  portion  of  the  left  innominate  bone,  spreading  to  the 
sacrum  and  destroying  its  left  auricular  surface  and  much  of  the 
bone  below  it.  The  acetabulum  was  intact,  but  the  disease  had 
spread  into  the  iliac  segment  of  the  cavity.  The  only  part  of  the 
ilium  left  was  the  anterior  three-fourths  of  the  crest,  the  antero- 
superior  spina,  and  a  small  arch  of  bone  behind  the  spine.  On  the 
right  side  the  ilium  was  intact,  but  here  the  disease  had  destroyed 
the  ischial  tuberosity  completely,  and  had  travelled  some  way  up 
the  ascending  ramus.1 

A  very  interesting  case  came  from  Heliopolis.2  In  this  skull, 
one  of  a  typical  Egyptian  adult,  there  had  been  a  severe  abscess, 
probably  due  to  the  exposure  of  the  pulp  cavity  of  the  upper  central 
incisor.  All  the  incisors  were  very  much  worn  and  the  roots  of  both 
left  incisors  opened  into  the  abscess  cavity  which  had  perforated  on 
to  the  face,  the  palate,  and  into  the  floor  of  the  nose  on  both  sides 

1  The  writer  has  not  seen  the  specimen  and  can  therefore  not  give  a  definite 
opinion,  Nut  the  diagnosis  of  cancer  of  the  jaw  with  metastases  in  the  pelvis  does  not 
appear  to  him  improbable. 

1  I'etric  and  Mackey,  Heliopolis,  Kafr,  Amur,  and  Sharufa,  p.  47. 


304         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

of  the  septum.  The  left  second  molar  was  carious  also,  and  its 
crown  had  gone.  In  the  mandible  there  were  primary  carious  spots 
on  the  second  bicuspid  and  first  molar. 

Many  people  from  Merawi  and  Faras  hada  bscesses  secondary 
to  caries  or  periodontitis.  The  second  mandibular  premolar  of  one 
skull,  for  instance,  was  deeply  carious  on  its  lingual  side,  and  the 
first  molar,  which  had  been  lost  during  life,  had  perhaps  been  carious 
also,  for  the  rough,  spongy  state  of  the  alveolus  bore  witness  to 
considerable  inflammation  in  its  neighborhood.  An  abscess  had 
formed  round  one  of  these  teeth,  probably  round  the  first  molar,  and 
the  pus  had  worked  its  way  firstly  from  one  alveolus  to  the  other, 
through  a  sinus  large  enough  to  admit  a  large  probe,  and  secondly 
into  the  mouth  on  the  labial  side  of  the  second  premolar. 

In  the  times  of  Cleopatra,  the  Egyptian  inhabitants  of  Alex- 
andria often  suffered  from  dental  abscesses  due  to  various  causes. 
Sometimes  the  abscesses  were  doubtless  due  to  the  entrance  of 
micro-organisms  through  an  open  dental  canal,  but  very  often  this 
was  not  the  probable  cause.  An  abscess  round  the  fang  of  the  left 
mandibular  second  premolar  of  one  case,  for  example,  had  evidently 
not  been  the  result  of  attrition  as  the  dental  canal  was  entirely  closed ; 
nevertheless  the  pus  had  ultimately  worked  its  way  into  the  buccal 
cavity  by  a  fistulous  opening  5  mm.  wide. 

The  etiology  of  these  abscesses  was  often  somewhat  obscure, 
as  in  the  case  of  an  old  Christian  woman1  with  numerous  maxillary 
alveolar  abscesses,  whose  right  maxillary  third  molar  was  retained 
and  ankylosed  to  the  bone,  the  right  temporo-mandibular  joint 
being  at  the  same  time  "disorganized"  by  arthritis.  The  abscess 
in  this  case  may  possibly  have  been  the  result  of  inflammation 
produced  by  the  retained  third  molar.  If  the  infection  had  spread 
from  the  exposed  pulp  to  the  apex  of  the  root  through  the  apical 
canal,  signs  of  softening  of  the  pulp  chamber  should  have  been 
evident,  whereas  in  many  cases  no  trace  of  such  previous  softening 
existed.  On  the  contrary,  except  in  teeth  obviously  carious,  the 
pulp,  though  freely  exposed,  appeared  hard  and  healthy,  this  state 
of  things  giving  no  support  to  the  theory  that  the  micro-organisms 
had  penetrated  through  the  apical  canal. 
lA.  S.  N.,p.  92. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        305 

The  pathological  processes  involved  in  the  production  of  ab- 
scesses in  some  skulls  were  sometimes  very  complex,  as  when  dental 
abscesses  co-existed  with  attrition  and  chronic  suppurative  peri- 
odontitis. In  such  cases  it  was  impossible  to  say  whether  the 
infective  agents  had  entered  through  the  apical  canal  or  through  the 
space  opened  up  by  suppuration  between  the  tooth  and  the  alveolar 
wall.  In  an  Alexandrian  skull,  the  tips  of  the  anterior  fangs  of  the 
left  mandibular  second  molar  dipped  into  two  small  abscesses,  each 
about  the  size  of  a  very  small  pea;  the  crown  was  somewhat  worn 
and  the  dental  canal  firmly  closed.  The  alveolar  wall  on  the  buccal 
side  had  been  almost  completely  absorbed  and  a  depression  round 
the  roots  of  the  left  third  molar  suggested  that  these  also  had  been 
bathed  in  pus.  In  this  case  rarefying  suppurative  periostitis  had 
evidently  opened  the  way  for  the  infective  agent. 

The  pathological  processes  which  resulted  in  the  formation  of 
another  mandibular  dental  abscess  were  still  more  complex.  In 
this  case  both  left  premolars  and  the  first  molar  had  been  lost 
during  life  and  the  left  second  molar  was  carious.  An  oval  opening 
with  smooth  borders,  measuring  12  by  8  mm.,  occupied  on  the 
alveolar  border  the  position  of  the  roots  of  the  absent  premolars. 
An  aperture  artificially  made  by  me  through  the  external  wall  of 
the  mandible  led  to  a  smooth-walled  cavity  measuring  3 .  5  by  2  cm., 
in  which  the  roots  of  the  second  incisor,  first  molar,  and  the  anterior 
fang  of  the  second  molar  protruded.  During  life,  therefore,  all 
these  roots  and  those  of  the  absent  premolars  had  been  bathed  in 
pus,  and  the  premolars  and  first  molars  had  evidently  either  fallen 
out  or  been  removed  some  time  before  death,  a  wide  fistula  remain- 
ing behind.  The  alveolar  walls  of  the  second  and  third  molars 
had  been  partly  absorbed  and  the  teeth  were  thickly  encrusted  with 
tartar. 

An  old  person,  with  teeth  somewhat  worn,  had  carious  right 
molars.  The  right  first  and  second  premolars  had  been  lost  just 
before,  or  had  dropped  out  after,  death,  though  not  before  their 
alveoli  had  been  converted  by  long  continued  suppuration  into  a 
cavity  measuring  17  by  12  mm.,  and  the  buccal  alveolar  wall  had 
been  absorbed,  with  the  exception  of  the  posterior  third  which  was 
perforated  by  a  small  opening  on  the  buccal  side.     Almost  the 


306         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

entire  roots  of  the  carious  first  molar,  and  to  a  less  extent  those  of 
the  neighboring  molars  were  exposed,  and  all  these  teeth  were 
covered  with  thick  tartar.  The  path  followed  by  the  infective 
agents,  therefore,  whether  through  a  carious  tooth  or  a  suppurating 
alveolar  border,  was  not  at  all  certain.  The  aetiology  of  many  of 
these  suppurations,  especially  in  the  maxillae  of  young  people, 
remained  obscure,  for  no  obvious  disease  was  found  either  in  the 
tooth  itself  or  its  neighborhood. 

Non-infectious  periodontitis  due  to  mechanical  causes  such  as 
blows,  etc.,  was  rare  in  ancient  Egypt,  for  no  cases  are  on  record; 
nor  were  there  any  reasons  to  suppose  that  intoxication  by  arsenic, 
mercury,  or  phosphorus  played  any  part  in  the  causation  of  dental 
disease.  The  majority  of  alveolar  and  perialveolar  abscesses  was 
evidently,  if  not  due  to,  at  any  rate  associated  with,  chronic 
suppurative  periodontitis. 

The  name  of  pyorrhoea  marginalis  is  given  to  a  group  of  well- 
defined  clinical  symptoms,  and  anatomically  it  has  all  the  charac- 
teristics of  chronic,  suppurating,  marginal  periodontitis.  The 
disease  is  now  considered  by  many  to  be  caused  by  an  amoeba,  the 
presence  of  which  in  Egypt  has  lately  been  demonstrated  by  Dr. 
Crendiropoulo,  my  assistant.1  In  modern  Alexandria  it  attacks 
the  English,  French,  Italians,  Greeks,  Egyptians,  Jews,  Berberine, 
and  negroes,  people  of  the  most  different  habits,  diatheses,  ages,  and 
conditions,  with  truly  international  impartiality.  The  author  has 
seen  it  in  two  members  of  the  same  household;  the  first,  an  Egyp- 
tian cook  whose  tartar-covered  teeth  had  never  been  brushed;  the 
second  a  fair  Englishwoman,  with  spotless  dentition,  who  had  never 
had  an  illness  except  infantile  measles. 

The  differences  between  the  periodontitis  caused  by  caries  and 
other  local  lesions,  and  the  periodontitis  of  pyorrhoea  marginalis, 
are  mainly  clinical;  the  first  being  limited  to  a  few  teeth  and  coming 
to  an  end  when  the  diseased  teeth  or  lesion  are  removed,  the  other 
being  a  chronic  disease,  usually  spreading  from  tooth  to  tooth  which 
remain  healthy.  Suppurating  chronic  periodontitis  occurred  in 
ancient  times  both  in  Europe  and  Africa.     In  Europe  the  fossil 

1  While  the  amoebae  are  constantly  found  in  this  disease  they  are  not  considered 
by  most  authorities  to  be  in  any  way  concerned  with  the  causation.     (J.  H.  M.) 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        307 

man  of  La  Chapelle-aux-Saints1  is  said  to  have  suffered  from 
pyorrhoea.  He  lived  in  the  Mousterian  period,  and  was  therefore 
certainly  a  hunter,  though  possibly  also  an  agriculturist. 

According  to  Baudouin,  who  described  fully  the  pathological 
alterations  of  this  skull,  the  alveolus  of  the  left  upper  canine  is 
diminished  in  depth  and  its  cavity  has  a  spongy  appearance,  doubt- 
less owing  to  the  long-standing  inflammation  which  led  to  the  loss 
of  this  tooth.  The  alveolus  of  the  left  first  upper  premolar  also  is 
shallower  than  normal.  The  alveoli  of  the  right  lower  incisors, 
canine,  and  first  premolar  form  large  irregular  cavities  due  to  the 
partial  absorption  of  their  walls.  The  alveolus  of  the  second  molar 
is  in  a  better  state  of  preservation  and  slopes  forwards.  All  the 
molars  were  lost  long  before  death,  and  the  alveoli,  having  been 
absorbed,  are  depressed  and  concave.  The  alveoli  of  the  left 
incisors  and  canine  are  well  preserved,  the  pathological  signs  are 
but  slight  and  their  diminished  depth  alone  attracts  attention. 
The  alveolar  border  behind  the  second  molar  having  been  absorbed, 
the  mandible  is  atrophied  correspondingly.  The  third  molar,  on  the 
other  hand,  was  lost  probably  only  just  before  death. 

It  is  very  probable  that  the  loss  of  his  molars  in  the  La  Chapelle 
man  was  the  result  of  pyorrhoea  alveolaris,  though  it  may  also  have 
been  caused  by  caries.  With  regard  to  the  other  alveolar  lesions  in 
this  skull  which  have  been  described  as  being  due  to  pyorrhoea, 
their  causation,  in  my  opinion,2  is  by  no  means  clear. 

The  diagnosis  of  pyorrhoea  alveolaris  was  made  in  the  case  of  a 
Neolithic  skull  also,3  in  which  all  the  left  mandibular  molars,  the 
second  maxillary  premolars,  and  all  the  molars  had  been  lost 
through  disease  during  life;  but  here  again  caries  may  have  been 
the  active  agent.  Such  cases  of  almost  total  destruction  of  teeth 
by  caries  occur  nowadays  in  Egypt.  I  have,  for  instance,  observed 
for  eighteen  years  a  man  who  during  that  period  has  lost  from  caries 
all  the  upper  teeth  with  the  exception  of  the  second  left  molar,  and 

1  Marcel  Baudouin,  "La  polyarthrite  alv£olaire  depuis  la  quaternaire  jusqu'a 
l'fpoque  romaine,"  Gas.  Med.,  Paris,  1913,  p.  397. 

3  My  opinion  is  based  on  an  excellent  cast  of  this  skull  only,  and  is  therefore 
provisional. 

J  Marcel  Baudouin,  loc.  cit. 


308         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

all  the  lower  teeth  with  the  exception  of  the  incisors,  canines,  and 
the  third  molars,  and  who  yet  had  never  a  sign  of  pyorrhoea.  It  is 
possible,  therefore,  that  both  the  above  subjects  had  lost  their  teeth 
through  caries.  The  writer  has  observed  similar  lesions  in  a  con- 
siderable number  of  ancient  skulls.1 

The  typical  lesions  of  chronic  periodontitis  marginalis  were  con- 
spicuous in  several  skulls  from  Merawi,  the  fangs  of  many  of  the 
teeth  being  bare  and  looking  as  if  they  had  been  pushed  out  of 
their  sockets.  This  early  stage  was  the  result  of  the  absorption  of 
the  alveoli  and  consequent  exposure  of  the  roots.  In  a  more 
advanced  stage,  the  alveolar  walls  had  completely  disappeared,  and 
consequently  the  fangs  were  exposed  for  a  considerable  length,  while 
in  a  still  more  advanced  condition  the  alveoli  were  almost  com- 
pletely absorbed  and  the  teeth,  on  the  point  of  being  shed,  remained 
attached  to  the  skull  by  the  tips  of  the  roots  only.  It  was  most 
probably  also  this  disease  which  was  responsible  for  some  edentu- 
lous ancient  Sudanese  skulls  with  alveolar  borders  completely 
destroyed. 

Skulls  from  Faras  in  Nubia,  from  the  time  of  the  Meroitic 
kingdom,  showed  the  same  typical  lesions.  This  is  specially 
interesting  because  the  disease  exists  now  at  Faras  as  it  did  two 
thousand  years  ago,  and  when  I  was  collecting  ancient  pathological 
specimens  there  I  was  consulted  by  many  members  of  the  present 
population  who  had  lost  most  of  their  teeth  from  pyorrhoea  and 
were  fast  shedding  the  remaining  few.  The  disease  is  spread  all 
over  Egypt  and  exists  even  in  remote  localities,  far  away  from  all 
civilization.  In  the  desert  of  Sinai,  on  the  gulf  of  Akaba,  I  found 
seven  men,  the  whole  garrison  of  a  small  isolated  fort,  who  had  the 
typical  symptoms  of  pyorrhoea  alveolaris,  and  were  in  a  wretched 
state  of  health  in  consequence. 

The  most  striking  pathological  lesions  in  ancient  Coptic  skulls 
were  perhaps  suppurative  periodontitis.  In  one  case,  for  instance, 
suppuration  had  completely  exposed  two  molar  teeth,  and  the 
pathological  process  had  extended  along  the  alveolar  borders  of  the 

1  It  is  rather  strange  that  the  report  in  the  A.S.N,  does  not  mention  the  presence 
of  this  disease  in  Nubia,  though  there  are  plain  indications  that  it  was  not  uncommon 
there. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        309 

maxillae  and  mandibles,  leaving  the  teeth  bare  and  most  of  them 
very  loose.  Such  lesions  were  extremely  common  at  that  period 
of  Egyptian  history. 

Interesting  as  were  the  Coptic  cases  and  those  from  Merawi  and 
Faras,  chronic  suppurative  periodontitis  of  the  ancient  Egyptians 
was  best  studied  on  Egyptian  predynastic  skulls,  in  which  the  lesions 
were  most  typical.  In  these,  the  first  lesions  were  usually  situated 
on  the  buccal  side  of  the  anterior  or  posterior  root  of  the  first  molar, 
the  alveolar  wall  being  partly  absorbed  and  the  root  thus  laid  bare 
for  some  distance.  The  remaining  alveolar  border  was  often 
riddled  with  small  holes  with  smooth  walls  and  borders,  evidently 
the  effect  of  unequal  destruction  of  bone  by  a  chronic  inflammatory 
suppurative  process.  A  more  advanced  stage  was  reached  when 
this  process  had  extended  between  the  roots  of  the  first  molar  and 
into  the  spaces  between  this  tooth  and  its  neighbors  on  one  or  both 
sides,  and  had  thus  given  rise  to  a  honeycombed  surface.  Owing 
to  the  continued  absorption  of  the  alveolar  wall,  the  whole  root  was 
laid  bare,  even  when,  as  sometimes  happened,  the  lesions  remained 
limited  to  the  root.  Absorption  was  nearly  always  most  marked 
on  the  buccal  side  of  the  first  molar  or  of  any  other  tooth  that  was 
attacked. 

The  suppuration  causing  the  disappearance  of  the  alveolar  wall 
and  the  loosening  of  the  tooth  appeared  to  follow  one  of  two  courses, 
which,  though  sometimes  combined,  were  nevertheless  fairly  dis- 
tinct. In  the  first,  most  often  observed  in  the  molar  region,  the 
absorption  of  the  alveolar  wall  starting  on  the  free  border  gradually 
extended  towards  the  apex  of  the  alveolus,  and  the  whole  or  nearly 
the  whole  alveolar  wall  was  absorbed,  often  without  the  formation 
of  an  abscess.  In  the  other,  the  disease  extended  to  the  bottom  of 
the  alveolus  without  marked  changes  being  noticeable  in  the  upper 
part  of  the  alveolar  wall,  but  the  bone  protecting  the  tip  of  the  root 
was  absorbed,  and  the  pus  found  its  way  into  the  mouth  through 
this  perforation  near  the  extremity  of  the  alveolus.  Repeated 
examination  gave  the  impression  that  the  first  process  is  typical  of 
an  acute  form  of  disease,  for  the  inflammatory  lesions  in  the  neigh- 
borhood were  severe.  The  second  indicated  a  more  chronic  form, 
in  which  the  infective  material,  having  penetrated  between  the 


310         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

tooth  and  the  alveolus,  had  produced  a  small  purulent  collection 
round  the  apex  of  the  root.  The  surface  of  the  maxilla  or  mandible 
behind  the  tip  of  the  fang  was  excavated  somewhat,  but  not  pitted, 
and  exhibited  no  obvious  signs  of  inflammation,  its  smooth  surface 
somewhat  resembling  a  stone  worn  down  by  the  prolonged  action 
of  water.  The  apex  of  the  fang  never  adhered  to  the  neighboring 
bone,  and  the  tooth  is  usually  tightly  held  by  what  remains  of  the 
alveolus.  The  irregular  pitting  caused  by  the  inflammatory  process 
often  extended  bilaterally  along  the  alveolar  borders  of  several  or 
all  the  maxillary  or  mandibular  teeth,  or  of  both.  As  a  rule,  how- 
ever, the  pathological  process  had  attacked  two  or  three  teeth  only 
and  had  extended  to  the  others  later  on,  for  when  several  alve- 
oli had  been  absorbed  during  life  in  a  skull  with  lesions  of  suppura- 
tive periodontitis,  the  disease  clearly  had  existed  long  before  death, 
and  after  causing  the  loss  of  several  teeth  it  had  spread  to  the 
alveoli  found  diseased  at  the  time  of  death. 

The  teeth,  even  when  the  walls  of  the  alveoli  had  been  almost 
completely  destroyed,  were  healthy  as  a  rule,  except  for  the  usual 
deep  attrition  of  ancient  Egyptian  teeth,  and  very  often,  though 
not  always,  for  more  or  less  thick  deposits  of  tartar.  Sometimes, 
however,  the  root  was  shortened  owing  to  absorption  of  its  tip  which 
was  then  smooth  and  rounded — -blunted,  so  to  speak.  Very  rarely 
the  roots,  although  smooth,  were  somewhat  uneven  as  if  a  slow 
process  of  ulceration  had  been  acting.  The  crown  itself  was  normal 
except  for  the  changes  due  to  attrition.  In  a  late  stage  the  alveolar 
septa  were  absorbed  and  the  teeth  might  then  he  in  a  cavity,  which 
during  life  was  doubtless  purulent.  As  the  septa  between  two  or 
more  neighboring  teeth  also  disappeared,  the  alveoli  of  several  teeth 
ran  together,  especially  in  the  molar  regions,  and  a  huge  cavity  was 
thus  formed  by  the  coalescence  of  several  alveoli. 

The  ultimate  result  of  the  process  in  the  Egyptian  skulls  was 
often  loss  of  the  teeth,  but  sometimes  before  this  occurred  some, 
especially  the  premolars  and  molars,  were  forced  out  of  position, 
owing  to  their  attachment  having  been  loosened  by  the  absorption 
of  the  alveolus  and  the  accompanying  suppuration.  The  teeth  had 
easily  yielded  to  the  presence  of  masticating  or  other  movements, 
and  had  been  ultimately  pushed  into  a  position  at  an  angle  with  the 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        311 

other  teeth.  The  tips  of  the  roots  of  the  "dislocated"  teeth  were 
thus  directed  towards  the  buccal  side,  and  the  roots  were  often  bare 
for  most  or  all  of  their  lengths  even.  Such  teeth  were  not  infre- 
quently firmly  fixed  in  their  new  position,  so  firmly,  indeed,  that 
their  removal  from  the  skull  was  not  at  all  easy,  and  sometimes  the 
life  of  the  bearer  had  been  prolonged  long  enough  for  a  new  masti- 
cating surface  to  have  formed  on  the  lateral  aspect  of  the  fang  lying 
at  right  angles  to  the  other  teeth. 

This  process,  then,  was  essentially  chronic,  spreading  from  tooth 
to  tooth  and  often  ending  in  the  loss  of  one,  several,  or  even  all  the 
teeth.  Very  probably  the  edentulous  maxillae  and  mandibles  dis- 
covered in  many  ancient  graveyards  had  been  rendered  so  by  this 
disease,  but  on  the  other  hand,  there  can  be  no  doubt  that  in  the 
large  majority  of  cases  the  disease  improved  locally  or  generally 
before  the  death  of  the  patient.  More  than  60  per  cent  of  predynas- 
tic,  dynastic,  Roman,  and  Coptic  Egyptians  had  one  or  several  teeth 
with  exposed  fangs,  sometimes  for  as  much  as  two-thirds  of  their 
length,  and  yet  the  alveolar  borders,  somewhat  thickened,  were 
smooth  and  even  and  the  teeth  themselves  were  healthy  and  firmly 
fixed  in  their  sockets.  This  condition  was  a  sign  that  the  disease  had 
become  dormant  after  producing  more  or  less  severe  lesions.  In 
many  cases  there  was  no  reason  to  doubt  that  the  disease  had  been 
cured  with  the  loss  of  one  or  several  teeth. 

The  etiology  of  this  condition  in  ancient  Egyptians  is  by  no 
means  clear.  The  examination  of  the  predynastic  and  dynastic 
Egyptian  skulls  from  Naga  el  Deir,  for  instance,  might  lead  to  the 
conclusion  that  tartar  had  played  a  considerable  role.  Deposits  of 
tartar  on  Egyptian  teeth  were  common  at  ah  periods  from  pre- 
dynastic to  Coptic  times,  being  laid  down  in  layers  round  the  tooth, 
and  being  always  thickest  at  the  margin  of  the  gum.  The  teeth  of 
other  ancients  besides  Egyptians  were  sometimes  thickly  covered 
with  it.  Herodotus1  relates  that,  after  the  battle  of  Plataea,  there 
was  found  a  skull  in  which  "the  upper  jaw  had  teeth  growing  in  a 
piece,  all  in  one  bone,  both  the  front  teeth  and  the  grinders."  The 
son  of  Prusias,  king  of  Bithynia,  and  the  king  Pyrrhus  are  said  to 
have  been  thus  affected.     Similar  cases  have  been  described  in 

'  ix.  83. 


312         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

modern  times,  where  several  or  all  the  teeth  even  were  imbedded 
in  solid  tartar. 

Its  presence  is  said  to  predispose  to  pyorrhoea  and  to  hasten  its 
progress  by  penetrating  between  the  gum  and  the  tooth,  or  between 
the  alveolus  and  the  tooth  and  thus  loosening  the  latter.  It  is 
impossible  to  decide  from  the  examination  of  a  skull's  teeth  whether 
the  tartar  was  deposited  before  or  after  the  inception  of  pyorrhoea, 
but  what  the  examination  does  show  is  that,  very  often,  the  deposit 
is  confined  to  the  necks  of  the  teeth.  It  would  appear,  therefore, 
that  tartar  did  not  in  those  days  play  the  important  part  which  it 
is  said  to  play  now,  and  that  in  many  cases  its  deposit  on  the  root 
was  of  little  if  any  pathogenic  importance.  The  tartar  was  in  many 
cases  rather  soft,  white,  and  was  fairly  easily  detached  with  the 
sharp  end  of  a  knife.  This  kind  was  most  often  seen  in  Roman, 
Coptic,  and  Greek  skulls,  whereas  the  brown  variety  was  more 
common  in  predynastic  Egyptian  skulls.  The  enamel  underneath 
was  perfect. 

Severe  chronic  suppurative  periodontitis  is  so  often  associated 
with  marked  attrition  of  the  teeth  that  the  question  arises  whether 
the  periodontal  disease  may  not  be  caused,  or  at  any  rate  rendered 
worse,  by  the  latter.  The  answer  to  this  question  without  clinical 
observations  is  well-nigh  impossible.  When  the  periodontitis  and 
the  subsequent  suppuration  and  perforation  into  the  mouth  were 
most  marked  at  the  apex  of  the  root,  it  is  fair  to  assume  that  the 
infecting  micro-organism  entered  by  the  dental  canal,  even  if,  as 
was  usuaUy  the  case,  the  pulp  was  unaltered.  On  the  other  hand, 
when  the  lesions  were  most  marked  at  the  alveolar  borders,  the 
probability  was  great  that  attrition  had  played  no  part.  In  many 
cases,  probably,  the  micro-organisms  causing  chronic  suppurative 
periodontitis  were  carried  mechanically  from  the  alveolar  margin 
to  the  crown  of  the  tooth  and  thus  reached  the  bottom  of  the 
alveolus  through  an  open  dental  canal. 

VI.   CORRELATION  OF  PATHOLOGICAL  PROCESSES 

Reading  through  the  field  notes  of  the  Archaeological  Survey  of 
Nubia,  the  frequent  coincidence  of  dental  disease  and  of  spondylitis 
deformans,  or  other  chronic  articular  lesions,  immediately  attracts 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        313 

notice.  These  notes,  it  may  be  added,  are  all  the  more  valuable 
because  both  observers  were  unprejudiced  as  to  any  theory  regard- 
ing a  possible  correlation  between  lesions  of  the  teeth  and  chronic 
joint  disease. 

Without  going  into  the  detail  cases,  a  perusal  of  the  records  of 
the  Survey  makes  it  plain  that  spondylitis  deformans  and  chronic 
osteo-arthritis  coexisted  in  many  cases  and  at  all  periods  of  Nubian 
history,  and  that  often  lesions  of  both  were  very  severe. 

The  connection  between  chronic  arthritis  and  dental  disease  is 
not  disproved  by  the  fact  that  in  many  cases  of  joint  disease  the 
dentition  was  stated  to  be  healthy,  for  two  reasons.  The  first  is 
that  in  almost  all  cases  of  spondylitis  the  teeth  were  greatly  worn, 
the  pulp  cavity  was  exposed,  and  thus  a  path  for  septic  absorption 
was  open.  The  second  is  that  no  mention  is  made  of  suppurative 
periodontitis  which  certainly  did  exist,  as  severe  and  multiple 
abscesses  at  the  roots  of  the  teeth  were  often  mentioned  and  attrib- 
uted to  infection  spreading  down  to  the  roots  through  the  med- 
ullary canal  opened  by  attrition.  Undoubtedly  infection  often 
entered  through  this  open  path. 

The  author's  opportunities  of  studying  both  diseases  clinically 
have  not  been  many,  but  the  few  observations  on  modern  male 
Europeans  and  Egyptians  in  Egypt  do  not  lead  him  to  think  that 
spondylitis  is  always  caused  by  dental  disease,  e.g.,  pyorrhoea 
alveolaris.  The  few  cases  of  chronic  spondylitis  (some  of  which 
have  lasted  for  years)  of  which  he  obtained  a  good  clinical  history, 
had  suffered  from  severe  gonorrhoea,  and  several  had  not  a  trace 
of  pyorrhoea.  Moreover,  pyorrhoea  alveolaris  is  extremely  com- 
mon in  Egypt  now,  whereas  cases  of  severe  chronic  spondylitis  are 
certainly  not  many.  It  is  clear,  however,  that  further  investigations 
in  these  lines  are  desirable! 

VII.      SYPHILIS,    RICKETS 

Neither  syphilitic  nor  rickety  teeth  were  discovered,  and  this 
observation  confirms  the  evidence  derived  from  the  study  of 
skeletons,  for  no  syphilitic  bone  dating  from  ancient  times  in  Egypt 
has  been  unearthed  so  far,  and  rachitis  was  very  rare  indeed  if  it 
existed. 


314         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Sometimes  the  teeth  were  transversely  striated,  which  was 
perhaps  caused  by  some  constitutional  disturbance. 

No  lesions  have  been  found  pointing  to  the  immoderate  use  of 
the  toothbrush,  and  indeed  there  is  no  definite  observation  proving 
that  ancient  Egyptians  used  this  instrument  of  torture.  The  teeth 
found  in  Alexandria  and  some  of  those  from  Faras  and  Merawi 
were  remarkably  clean  and  white,  as  a  rule,  and  this  may  have  been 
due  to  the  use  of  some  cleaning  instrument  during  life ;  on  the  other 
hand,  the  predynastic,  dynastic,  and  Coptic  teeth  were  often 
covered  with  a  thick  layer  of  tartar. 

VIII.       DENTISTRY 

The  writer's  studies  have  not  revealed  any  facts  showing  that 
the  Egyptians  practised  operative  dentistry,  in  fact,  the  evidence 
rather  points  to  the  conclusion  that  even  extraction  was  very 
seldom  performed.  It  is  not  rare  to  find  in  Egyptian  cemeteries 
diseased  teeth  almost  dropping  out  of  abscess  cavities,  or  carious 
teeth  which  have  caused  extensive  disease,  and  yet  the  patient  was 
allowed  to  die  without  the  relief  that  would  have  been  afforded  by 
a  very  simple  operation.  It  is  difficult  to  believe  that  extrac- 
tions were  not  practised  at  times,  but  the  evidence  on  that  point 
is  nil. 

No  tooth  filled  with  gold  or  any  other  metal  has  been  found. 
The  only  set  of  artificial  teeth  that  has  been  discovered  comes  from 
a  Roman  grave  and  is  deposited  in  the  Alexandria  Museum. 
Clearly  it  could  have  been  of  but  little  use  in  chewing  and  was 
probably  tied  in  for  aesthetic  purposes  only. 

A  similar  set  of  teeth  comes1  from  a  grave  of  old  Sidon,  and  two 
copper  coins,  an  iron  ring,  a  vase  of  most  graceful  outline,  a  scarab, 
and  twelve  very  small  statuettes  of  majolica  representing  Egyp- 
tian divinities,  were  found  in  the  same  grave.  It  consisted  of  four 
lower  incisors  (not  "maxillary"  as  Gaillardot  stated),  and  two 
canines  held  together  by  strong  gold  wire.  Guerini  pointed  out 
that  teeth  strung  together  in  the  same  manner  are  now  being  used 
in  India. 

1  In  Renan's  Mission  de  Phenicie.     See  also  Guerini,  History  of  Dentistry,  p.  20. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        315 

IX.      CONCLUSIONS 

i.  Among  ancient  Egyptians,  anomalies  in  position,  structure, 
and  number  of  the  teeth  were  rare  and  did  not  seem  to  become 
more  common  as  modern  times  were  approached. 

2.  Attrition  was,  as  it  is  now,  very  marked,  and  played  probably 
a  considerable  part  in  favoring  the  entrance  of  the  micro-organisms 
of  suppuration,  but  not  of  those  producing  caries. 

3.  Dental  caries  occurred  at  all  periods  of  Egyptian  history. 
It  is  impossible  to  say  for  certain  without  more  extensive  statistics 
whether  caries  was  much  less  common  in  ancient  than  in  modern 
times,  but  the  data  from  Tourah  undoubtedly  point  to  a  very  small 
percentage  of  caries  in  the  predynastic  period.  Nothing  definite 
is  known  regarding  the  incidence  of  caries  in  children. 

4.  Alveolar  and  perialveolar  abscesses  were  common  at  all  times 
in  Egypt,  and  were  evidently  produced  by  the  same  processes  as 
they  are  now.  Attrition  played  some  part  in  the  etiology  of  these 
abscesses,  but  the  majority  were  secondary  to  chronic  suppurative 
periodontitis,  and  a  few  to  caries. 

5.  Chronic  suppurative  periodontitis  was  a  common  disease  in 
ancient  Egypt,  and  the  most  frequent  cause  of  the  loss  of  teeth. 

6.  Spondylitis  and  osteo-arthritis  were  in  numerous  Nubians 
and  Egyptians  with  diseased  dentition,  but  a  definite  connection 
between  the  two  affections  has  not  been  established. 

7.  No  syphilitic  or  rachitic  teeth  have  been  found  in  the  Egyp- 
tians up  to  and  including  the  Coptic  period. 

8.  There  is  no  evidence  to  show  that  the  toothbrush  was  in 
common  use,  and  no  such  instrument  has  been  found  in  Egyptian 
tomb  deposits,  but  the  Alexandrians  and  the  people  from  Merawi 
and  Faras  appear  to  have  used  some  cleaning  instrument. 

9.  The  severity  of  many  of  the  lesions  found  post  mortem — 
lesions  which  were  undoubtedly  very  painful  and  could  have  been 
easily  relieved — show  that  dentists  did  not  interfere  operatively  in 
many  if  any  cases. 

10.  A  set  of  false  teeth  has  been  found  dating  from  Roman 
times.  This,  however,  like  the  one  found  at  Sidon,  was  perhaps 
imported  from  Italy  or  Greece. 


316         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

No  one  realizes  more  than  the  writer  how  incomplete  this  paper 
is,  especially  as  regards  statistics  concerning  the  incidence  of  dental 
disease  at  various  periods  of  Egyptian  history,  and  the  reason  for 
this  important  lacuna  is  that  the  material  which  has  been  examined 
is  unsuitable  for  statistical  study.  Satisfactory  statistics  of  dental 
disease  will  be  obtained  only  when  large  cemeteries  containing 
bodies  of  several  periods  are  excavated  with  due  regard  to  pathologi- 
cal study;  but  up  to  the  present,  except  in  a  very  few  cases, 
archaeologists  have  been  more  concerned  about  the  objects  found 
around  skeletons  than  about  the  skeletons  themselves. 


DESCRIPTION  OF  PLATES  LV-LXII 


Fig.  i. — Predynastic,  Naga  el  Deir.    Abnormalities  of  roots  of  molars. 

Fig.  2. — Predynastic.  Attrition  of  molars  and  premolars,  crowding  of 
incisors. 

Fig.  3. — Ancient  Nubian.  Young  adult.  Accessory  dental  unit  situated 
to  lingual  side  of  interval  between  right  posterior  premolar  and  first  molar. 

Fig.  4. — Predynastic.  Great  and  oblique  attrition  of  incisors  and  canines. 
Roots  of  premolars  fused,  labial  wall  of  alveolus  has  disappeared,  partly  owing 
to  post-mortem  injury;  there  is,  however,  evidence  of  suppuration  on  the 
distal  side  of  the  posterior  premolar.  The  molars  disappeared  long  before 
death. 

Fig.  5. — Xlth  Dynasty  (from  Murray's  "The  Tomb  of  Two  Brothers"). 
Well-marked  attrition;   a  supernumerary  incisor;  a  bifid  incisor. 

Fig.  6. — Nubia.     Supernumerary  tooth  at  (a).     (A.  S.  N.) 

PLATE  lvi 

Fig.  1. — From  Ras  el  Tin,  Roman  period.  Alveolus  of  a  tooth  which  was 
irregularly  placed.  Most  teeth  lost  after  death.  Right  canine  and  anterior 
premolar  broken  probably  after  death.  Molar  regions  show  signs  of  severe 
dental  and  perialveolar  disease. 

Fig.  2. — Predynastic,  Naga  el  Deir.  Alveoli  of  second  molar  and  posterior 
premolar  absorbed.  Crowns  of  canine  and  anterior  premolar  show  great  attri- 
tion, especially  on  buccal  side,  whereas  in  the  first  molar  the  center  of  the  crown 
is  the  part  worn  down  most  deeply.  Canine  covered  with  tartar  at  the  neck. 
Some  absorption  of  the  alveoli  of  all  the  teeth,  most  marked  round  the  root  of 
first  premolar  which  is  bare  for  its  whole  length,  and  the  wall  opposite  the  tip 
of  the  root  is  smooth  and  rounded.     Alveoli  round  roots  of  first  molar  also 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        317 

partly  absorbed;  that  of  second  premolar  almost  completely  absorbed,  doubt- 
less owing  to  long  previous  suppuration.     Malposition  of  third  molar. 

Fig.  3. — Cleopatra's  period.  Faulty  implantation  of  third  molar.  Alveo- 
lus of  second  molar  completely  absorbed. 

Fig.  4. — Pyramid  period  (?).  Some  malposition  of  third  lower  molar; 
corresponding  maxillary  tooth  is  much  smaller  than  its  neighbor.  Mandibular 
molars  somewhat  bare,  alveolar  borders  showing  signs  of  inflammation;  second 
lower  premolar  bare  and  with  distinct  pitting  of  alveolar  border.  Roots  of 
third  upper  molar  bare,  absorption  of  alveolar  walls  of  first  and  second  molars 
due  to  pathological  process  which,  judging  from  the  smoothness  of  the  borders, 
was  healing  at  the  time  of  death. 

Fig.  5. — From  Ras  el  Tin,  Roman  period.  Second  left  molar  shows 
small  oblong  enamel  nodule.  Some  absorption  of  alveolar  wall  of  same 
tooth. 

Fig.  6. — A  Gizeh  pyramid-builder.  Third  molar  lower  abnormally  situ- 
ated, corresponding  upper  tooth  much  smaller  than  its  neighbor.  Second 
molar  lost  during  life,  alveolus  almost  completely  absorbed.  Part  of  anterior 
root  of  first  molar  bare,  but  process  of  absorption  appears  to  have  stopped 
before  death.  Roots  of  anterior  premolar  and  canine  bare  for  about  two- 
thirds  of  their  lengths.  Alveolar  border  of  the  three  upper  molars  partly 
absorbed,  leaving  considerable  part  of  roots  completely  bare.  Borders  of  pre- 
molars and  canine  show  marked  signs  of  perialveolar  inflammation. 

PLATE   LVTI 

Fig.  1. — From  a  pan  grave  at  Ballalish.  Early  attrition  of  teeth.  Third 
molar  almost  normal;  second  worn  flat  without  formation  of  cavities;  in  first 
molar  attrition  more  advanced,  a  cavity  has  formed  on  the  proximal  lingual 
and  another,  smaller,  on  distal  lingual  side.  In  first  right  molar  similar  cavities 
have  coalesced.  Remaining  teeth  show  slight  attrition,  most  marked  in  the 
first  premolars  in  which  three  small  cavities  are  forming. 

Fig.  2. — From  a  pan  grave  at  Ballalish.  Early  stage  of  attrition  of  all 
teeth.  Incisors  show  narrow  central  groove  in  the  biting  edge.  Attrition  of 
first  molar  characteristic:  right  tooth  worn  into  four  distinct  cavities,  of  which 
the  two  on  the  buccal  side  are  coalescing.  On  left  the  two  buccal  and  the 
distal  cavities  have  united  into  one,  the  fourth  being  still  separate.  Second 
molars  are  slightly  worn  with  formation  of  cavities  near  proximal  surface. 
Third  molar  practically  normal. 

Fig.  3. — From  a  pan  grave  at  Ballalish.  Early  attrition  in  a  young  adult, 
not  marked  near  lingual  border  of  first  molar.  Cavities  in  first  and  third 
molars. 

Fig.  4. — Predynastic,  Naga  el  Deir.  Advanced,  somewhat  irregular 
attrition. 

Fig.  5. — Cleopatra's  period.  Second  molar  lost  before  death,  roots  of  all 
remaining  teeth  partly  bare.     Posterior  premolar  reduced  to  a  carious  stump 


318         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

at  apex  of  which  there  is  an  abscess  cavity,  which  communicates  with  alveolar 
cavity  of  proximal  root  of  first  molar. 

Fig.  6. — Gizeh  pyramid.  Crown  of  first  molar  completely  destroyed  by 
caries,  leaving  two  carious  stumps.  Tip  of  the  posterior  root  almost  completely 
absorbed.  Alveolar  wall  had  disappeared  during  life,  bone  underneath  partly 
eaten  away.  Anterior  root  of  the  same  tooth  is  almost  completely  bare.  Roots 
of  second  and  anterior  root  of  third  molar  also  bare,  but  some  of  the  injury  to 
alveolar  wall  probably  post  mortem.  Perialveolar  lesions  of  other  teeth  are 
slight,  but  all  along  alveolar  border  and  for  some  distance  below  signs  of 
chronic  inflammation. 

plate  LVIII 

Fig.  i. — Cleopatra's  period.  Maxilla  of  an  elderly  person.  Crowns  of 
remaining  teeth  show  great  attrition,  especially  left  premolars  and  first  left 
molar.  Beginning  caries  of  this  tooth  on  its  approximal  border.  Caries  of 
left  second  molar  posteriorly.  First  right  premolar  broken  after  death.  All 
right  molars  lost  during  life.     Hole  seen  at  (x)  made  after  death. 

Fig.  2. — Predynastic,  Naga  el  Deir.  Lesions  of  chronic  suppurating 
periodontitis  along  whole  length  of  alveolar  border.  Roots  of  incisors  and 
canine  bare  for  some  distance,  and  alveolar  border  over  lateral  incisor  pitted. 
First  premolar's  root  bare  and  tip  of  alveolar  wall  absorbed,  only  a  narrow 
bridge  of  bone  being  left.  The  tooth  is  much  worn.  Second  premolar  shows 
similar  changes,  and  bone  about  tip  of  the  root  and  all  round  deeply  pitted  as 
result  of  suppuration.  Almost  whole  of  alveolar  wall  of  first  molar  absorbed, 
and  remainder  carried  by  chronic  periodontitis.  Alveolar  margin  round  two 
remaining  molars  somewhat  pitted.     All  teeth  show  yellow  tartar. 

Fig.  3. — Coptic.  Advanced  oblique  attrition;  signs  of  alveolar  sup- 
puration. 

Fig.  4. — Predynastic,  Naga  el  Deir.  Advanced  attrition;  incisors  and 
canines  deeply  worn  on  lingual  side.  Dental  canal  of  all  premolars  opened. 
Marked  signs  of  chronic  suppuration  round  the  side  of  first  right  molar  which 
has  been  shed  during  life  and  the  alveolus  of  which  is  partly  obliterated,  and 
round  second  premolar  on  same  side  the  buccal  wall  of  whose  alveolus  has  been 
absorbed;  the  tooth  has  been  "dislocated,"  so  that  its  root  lies  almost  at  a 
right  angle  to  those  of  other  teeth.  The  tooth  had  become  firmly  fixed  in  that 
position,  for  a  small  flat  surface,  evidently  the  result  of  mastication,  had  formed 
on  the  side  of  the  root.  Lesions  of  chronic  periodontitis  exist  all  along  the 
alveolar  borders  of  both  remaining  right  molars,  canines,  and  incisors.  Left 
second  premolar  with  first  and  second  molars  were  shed  during  life  as  a  result 
of  process  resembling  that  noticeable  on  the  right  side. 

Fig.  5. — Xllth-XVIth  Dynasties.  Interior  root  of  first  molar  contained 
in  a  smooth-walled  cavity,  result  of  previous  inflammation  and  suppuration 
(suppurative  periodontitis),  tip  of  root  surrounded  by  layer  of  new  bone. 
Superficial  periostitis  below  first  molar. 


ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH         319 

PLATE  LTX 

Fig.  1. — Coptic  skull.  Advanced  caries  of  first  right  molar.  A  sinus  had 
formed  and  pus  had  perforated  through  palate.  The  sinus  leading  from  tooth 
to  palate  was  still  plain. 

Fig.  2. — Macedonian  period,  Chatby.  Attrition  of  teeth  which  are 
planted  somewhat  irregularly.  Large  accumulation  of  tartar  at  junction  of 
root  of  first  right  molar  with  the  crown;  tooth  dislocated  towards  the  labial 
side  owing  to  intense  suppurative  periodontitis;  small  perforation  in  the  crown 
of  the  tooth  accidental. 

Fig.  3. — Predynastic,  Naga  el  Deir.  Advanced  and  irregular  attrition. 
An  abscess  about  posterior  root  of  first  right  molar. 

Fig.  4. — Coptic  period.  Alveolus  of  left  anterior  premolar  completely 
absorbed,  a  thin  bridge  of  bone  superiorly  being  all  that  remains  of  it;  pus 
had  evidently  burrowed  into  the  neighboring  parts  of  the  mandible;  alveolus 
itself  of  normal  size.  In  neighboring  teeth  same  process  has  been  going  on, 
for  the  roots  are  partly  bare,  and  at  apex  of  root  of  posterior  premolar  a  sinus 
has  been  formed.  Other  side  was  equally  badly  afflicted  and  upper  jaw  of 
same  skull  is  almost  edentulous,  and  had  been  so  for  some  time  before  death, 
for  the  alveoli  had  been  so  completely  absorbed  that  not  a  trace  is  left.  The 
suppurating  process,  therefore,  had  attacked  the  whole  mouth  and  had  lasted 
for  years  before  the  patient  finally  succumbed. 

Fig.  5. — Roman  period,  Kom  el  Shougafa.     Roots  almost  completely  bare. 


Fig.  1. — Coptic  skull.  All  roots  exposed.  Lower  third  molar  lost  during 
life,  its  alveolus  completely  absorbed.  Second  molar  has  deep  carious  cavity 
on  buccal  side  of  root.  Alveoli  of  second  and  first  molars  completely  absorbed 
on  the  buccal  side,  probably  owing  to  long-continued  suppuration.  Roots  of 
the  other  teeth  also  bare. 

Fig.  2. — Predynastic,  Naga  el  Deir.  Third  molar  fell  out  during  life, 
and  there  are  signs  of  perialveolar  inflammation  at  (a).  Roots  of  second 
molar  completely  bare,  lying  in  open  cavities  which  doubtless  were  filled 
with  pus  during  life.  Signs  of  chronic  periodontitis  all  along  the  alveolar 
border. 

Fig.  3. — From  a  pan  grave,  Ballalish.  Deep-seated  abscess  connected  with 
alveolus  of  lateral  incisor,  perforating  through  the  palate  into  mouth. 

Fig.  4. — Cleopatra's  period,  Ras  el  Tin.  First  molar  wholly  bare,  owing 
to  chronic  rarefying  periostitis.  Roots  of  premolars  partly  bare;  second  and 
third  molars  nearly  normal. 

Fig.  5. — Cleopatra's  period,  Ras  el  Tin.  Both  left  premolars  and  first 
molar  lost  during  life  and  left  lateral  incisor  carious.  An  oval  opening  with 
smooth  borders,  12  by  8  mm.  in  outer  wall  of  the  jaw  in  alveolar  border,  in 
premolar  region.     An  aperture  artificially  made  through  the  external  wall  of 


320         STUDIES  IN  THE  PALAE0PATH0L0GY  OF  EGYPT 

the  mandible  leads  into  a  smooth-walled  cavity,  36  by  2  mm.,  in  which  roots  of 
canine,  lateral  incisor,  and  anterior  root  of  second  molar  are  exposed.  During 
life,  therefore,  these  roots  lay  in  extensive  abscess  cavity  which,  after  the  pre- 
molars and  first  molars  had  been  lost,  communicated  by  a  wide  opening  with 
the  mouth. 

Fig.  6. — Predynastic,  Naga  el  Deir.  Molars  and  premolars  with  advanced 
lesions  of  periodontitis,  most  marked  round  first  and  second  molars.  Many 
little  pits  due  to  the  inflammatory  process  seen  along  whole  length  of  alveolar 
border. 

PLATE  LXI 

Fig.  1. — Predynastic,  Naga  el  Deir.  Incisors  lost,  crowns  of  canine  and 
first  molar  broken,  probably  post  mortem.  Crowns  of  premolars  and  first 
molar  markedly  and  obliquely  worn.  Root  of  second  molar  bare  for  consider- 
able length,  and  near  its  tip  there  is  a  deep  cavity  which  connects  with  alveoli 
of  second  and  first  molars. 

Fig.  2. — Predynastic,  Naga  el  Deir.  The  third  molar  was  evidently  very 
small.  Root  of  second  molar  somewhat  exposed  and  crown  distinctly  worn. 
One  root  of  first  molar  bare  for  almost  its  whole  length.  Distinct  pitting  round 
the  roots  of  the  premolars  which  are  bare. 

Fig.  3. — Predynastic,  Naga  el  Deir.  Crown  of  first  molar  deeply  worn, 
root  surrounded  by  open  space  which  during  life  was  doubtless  filled  with  pus. 
Signs  of  inflammation  all  round  this  root  and  for  some  distance  along  the 
palate.  Second  molar's  root  partly  bare,  crown  worn.  Third  molar  was 
probably  small. 

Fig.  4. — Predynastic.  Abscess  cavity  at  base  of  first  premolar  which  was 
shed  before  death.  Crown  of  second  premolar  broken  post  mortem,  its  alveolar 
wall  completely  absorbed,  and  alveolus  evidently  communicated  with  abscess 
cavity  of  first  premolar.  The  upper  part  of  abscess  wall  especially  near 
alveolar  border  shows  signs  of  active  pathological  process,  whereas  lower 
part  of  wall  is  smooth,  rounded  as  if  pathological  process  had  been  quiescent 
there.  Tip  of  root  of  second  premolar  is  rounded  off  as  if  part  had  been 
absorbed. 

Fig.  5. — Cleopatra's  period,  Ras  el  Tin.  Right  incisor  and  canine  lost 
after  death,  second  and  third  molars  during  life.  Whole  left  molar  and  pre- 
molar region  is  changed  into  a  huge  cavity  with  spongy  wall,  owing  to  absorp- 
tion of  alveolar  and  interalveolar  septa. 

Fig.  6. — Meroitic  kingdom,  Faras.  Middle-aged  person.  Completely 
edentulous  upper  jaw. 

Fig.  7. — Predynastic,  Naga  el  Deir.  Advanced  suppurative  periodontitis. 
All  the  teeth  were  shed  during  life  and  the  alveoli  with  their  borders  show 
signs  of  inflammation  and  suppuration. 


PLATE  LV 


PTATE  LVI 


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PLATE  LVIII 


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PLATE  LIX 


PLATE  LX 


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ABNORMALITIES  OF  ANCIENT  EGYPTIAN  TEETH        321 

PLATE  LXII 

Fig.  1. — Coptic  period.    Transverse  striation  of  teeth. 

Fig.  2. — Coptic  period.  Old  woman.  Completely  edentulous  upper  jaw. 
Alveolar  process  has  entirely  disappeared. 

Fig.  3. — Predynastic,  Naga  el  Deir.  Most  teeth  lost  during  life,  possibly 
owing  to  chronic  periodontitis.  Enlarged  blood-vessel  canals  all  over  the 
palate. 

Fig.  4. — Predynastic,  Naga  el  Deir.  Edentulous  maxilla  with  alveolar 
borders  almost  completely  absorbed.  Foramina  of  blood  vessels  on  palate 
enlarged. 

Fig.  5. — Meroitic  kingdom.  Middle-aged  man.  Completely  edentulous 
mandible  and  almost  completely  edentulous  upper  jaw. 

Fig.  6. — Meroitic  kingdom.     Edentulous  skull. 


ON    THE    PHYSICAL    EFFECTS    OF    CONSANGUINEOUS 

MARRIAGES  IN  THE  ROYAL  FAMILIES 

OF  ANCIENT  EGYPT 

{Proceedings  of  the  Royal  Society  of  Medicine,  Section  of  the  History 
of  Medicine,  XII  [1919],  145-90) 

The  question  of  the  effect  on  the  offspring  of  marriage  between 
blood  relations  is  still  an  open  one.  Whereas  the  view  that  the 
children  of  consanguineous  marriages  are  likely  to  be  weak  and  to 
be  the  bearers  of  some  congenital  defect  is  widely  held,  some  stu- 
dents of  heredity  maintain  that  the  facts  on  which  this  view  is 
based  are  not  Convincing;  and  it  must  be  admitted  that,  from  the 
same  data,  divergent  conclusions  have  been  drawn.  Thus  the 
Veddahs  of  Ceylon  systematically  practise  consanguineous  marriage, 
and  some  years  ago  a  lurid  picture  was  drawn  of  the  evil  effects 
of  these  unions.  The  race,  it  was  asserted,  was  becoming  extinct, 
the  people  were  stupid,  sullen,  and  degenerated,  children  had 
disappeared  from  the  villages,  in  which  adults  only  were  to  be  seen, 
and  so  on.  Yet  these  fears  were  groundless,  for  the  Veddahs  have 
remained  a  very  simple,  harmless,  and  monogamous  tribe. 

In  Europe  the  marriage  of  first  cousins  is  not  uncommon,  but 
the  effect  of  such  unions  on  the  offspring  is  still  a  matter  for  contro- 
versy, and  some  medical  men  categorically  deny  its  dangers.  Again 
the  evidence  is  conflicting.  At  the  Institution  for  Deaf-mutes  in 
Paris,  for  instance,  the  percentage  of  deaf-mutes  born  from  con- 
sanguineous marriages  was  28.35  Per  cent>  whereas  in  similar 
Scotch  and  English  institutions  it  amounted  to  5.17  per  cent  only. 

The  investigations  of  George  Darwin  did  not  reveal  any  distinct 
connexion  between  infertility,  deaf-mutism,  insanity  or  idiocy  and 
consanguineous  marriages;  but  this  observer  thought  that  the 
vitality  of  the  children  of  first  cousins  was  somewhat  below  normal, 
and  that  the  death-rate  was  slightly  higher  than  in  the  offspring  of 
other  unions.  Observations  made  in  France  and  in  Denmark  do  not 
seem  to  prove  the  peril  of  such  unions,  and  the  facts  collected  in 
non-European  countries  are  not  convincing.     When,  for  instance, 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  323 

the  enormous  mortality  among  Persian  children  is  attributed  to 
consanguineous  marriages,  the  fact  that  in  certain  Eastern  towns 
the  death-rate  in  children  less  than  one  year  old  amounts  to  30  per 
cent  should  be  first  accounted  for. 

Nevertheless,  the  majority  of  modern  people  exhibit  in  their 
legislation  a  conviction  of  the  perils  of  consanguineous  marriage,  and 
believe  that  all  kinds  of  evils  threaten  the  offspring  of  such  unions. 
It  is  strange,  however,  that  this  idea  appears  to  be  entirely  modern, 
for  although  some  ancient  peoples  were  opposed  to  incestuous 
marriages,  there  is  no  reason  to  believe  that  this  prohibition  was  due 
to  a  belief  in  evil  results  to  the  offspring. 

Marriage1  with  a  half-sister,  not  uterine,  occurred  in  Athens,  in 
late  times.  The  Greeks  and  Romans  of  the  classical  period  looked 
upon  incest  as  a  crime,  though  voices  occasionally  inquired  the 
reason  for  this  opinion,  and  the  fable  of  Myrrha,2  who  conceived  an 
incestuous  passion  for  her  father,  is  well  known.  The  heroine 
pointedly  asks  why  incest  should  be  a  crime  among  men  when  it  is 
the  rule  among  animals.  "Defend  me,"  she  cries,  "from  a  crime 
so  great!  if  indeed  this  be  a  crime.  It  is  not  considered  shameful 
for  the  heifer  to  mate  with  her  sire;  his  own  daughter  becomes  the 
mate  of  the  horse;  the  he-goat,  too,  consorts  with  the  flocks  of 
which  he  is  the  father;  and  the  bird  conceives  by  him  from  whose 
seed  she  herself  is  conceived.  Happy  they  to  whom  these  things  are 
allowed!  The  case  of  man  has  provided  harsh  laws,  and  what 
Nature  permits,  malignant  ordinances  forbid. "  Myrrha  goes  on  to 
envy  the  fate  of  the  nations  which  allow  incestuous  relationships. 

Consanguineous  marriages  were  not  uncommon  in  early  Hebrew 
records:  Sarah  was  Abraham's3  half-sister;  during  Jacob's  life 
marriages  between  first  cousins  were  allowed;  Moses4  sprang  from 
a  marriage  between  a  nephew  and  his  paternal  aunt;  and  even 
in  David's  times  a  marriage  between  half-brother  and  sister  was 
allowed. 

In  Egypt,  from  very  early  times,  marriages  between  brother  and 
sister  were  fashionable,  whereas  incestuous  unions  between  father 

'  Robertson  Smith,  Kinship  and  Marriage,  p.  191. 

2  Ovid  Metamorphoses  x.  8. 

J  Gen.  20:12.  <  Num.  26:59.  5  II  Sam.  13: 13. 


324 


STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 


and  daughter,  or  mother  and  son,  were  very  rare,  if  indeed  they  ever 
took  place.  The  Egyptian  gods  themselves  had  set  the  example  of 
incest;  Keb,  the  earth-god,  and  Nut,  the  sky-goddess,  had  four 
children — two  sons,  Osiris  and  Set,  and  two  daughters,  Isis  and 
Nephthys — and  children  were  taught  that  Osiris  married  Isis  and 
Set  took  Nephthys  to  wife.  Isis'  lament  at  the  loss  of  Osiris  leaves 
one  in  no  doubt  as  to  the  relationship  between  the  two:  " Come  to 
her  who  loves  thee,  who  loves  thee,  Wennoffre,  thou  blessed  one. 
Come  to  thy  sister,  come  to  thy  wife,  thou  whose  heart  is  still. 
Come  to  her  who  is  mistress  of  thy  house.     I  am  thy  sister,  born  of 

the  same  mother,  thou  shalt  not  be  far  from  me Thou  lovest 

none  beside  me,  my  brother,  my  brother." 

The  royal  families  followed  this  lead.  Throne  and  property 
being  inherited  through  the  woman,  mother  or  wife,  as  legal  head  of 
the  house,  it  was  very  doubtful,  says  Petrie,  "whether  a  king  could 
reign,  except  as  the  husband  of  the  heiress  of  the  kingdom.  "  As  the 
king  was  the  ruler,  while  the  queen,  though  the  heiress  to  the  throne, 
had  no  executive  power,  the  only  way  to  keep  the  regal  power  in  the 
family  was  for  the  nearest  male  descendant  of  a  king  to  marry  the 
heiress,  who  was  very  often  his  sister.  In  considering  this  relation- 
ship, as  described  in  Egyptian  records,  caution  is  however  necessary. 
The  word  "sister,"  often  a  euphemism  for  mistress  or  concubine, 
also  meant  sometimes  the  wife  of  a  temporary  marriage,  or  was  even 
used  as  a  term  of  endearment.  The  confusion  has  been  increased 
by  the  fact  that  "Royal  Sister"  was  one  of  the  queen's  titles,  which 
did  not  imply  that  Her  Majesty  stood  in  that  relationship  to  her 
consort.  Therefore,  in  this  study,  I  shall  consider  a  king  and  queen 
to  have  been  brother  and  sister  only  when  there  is  sure  evidence  that 
they  were  so  related. 

The  marriages  of  brothers  and  sisters  were  frequent  among  com- 
mon people  also  as  late  as  Greek,  Roman,  and  early  Christian  times. 
Diodorus  Siculus,1  at  the  beginning  of  our  era,  mentions  such 
marriages  among  Egyptians.  An  Amherst  papyrus2  contains  an 
application  from  a  woman  asking  that  her  son  Artemon  might  be 
admitted  to  the  list  of  privileged  persons  wholly  or  partially  exempt 

1  Diodorus  Siculus  i.  i. 

2  Grenfell  and  Hunt,  Amherst  Papyri,  p.  90,  No.  75. 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  325 

from  the  poll-tax.  The  basis  of  the  claim  is  that  the  ancestors  of  the 
boy  on  both  sides  were  descendants  from  a  gymnasiarch,  and  that 
therefore  the  boy  himself  had  the  right  to  be  included  among  those 
"of  the  gymnasium."  The  genealogy  of  Artemon  reveals,  on  the 
mother's  side  at  least,  three  successive  cases  of  intermarriage 
between  brother  and  sister. 

The  custom  persisted  during  the  early  Christian  era.  A  papy- 
rus,1 dating  from  a.d.  108,  gives  a  marriage  contract  between  a 
certain  Apollonios,  a  Persian  ttjs  eiriyovrjs,  and  his  sister  Tapeutis; 
another  Persian  married  his  sister  Marouti,  and  a  third  married  his 
sister  Erieus.  Wessely2  published  several  genealogical  tables  of 
Egyptian  families  from  which  it  appears  that  in  four  well-to-do 
families  incestuous  marriages  were  in  the  majority,  and  it  has  been 
stated3  that,  under  the  emperor  Commodus,  two-thirds  of  the 
citizens  of  Arsinoe  had  married  their  sisters. 

As  consanguineous  unions  were  so  common,  the  evil  results 
should  have  been  numerous  and  have  attracted  popular  notice. 
Yet,  as  far  as  I  know,  no  such  observations  are  recorded  in  Egyptian 
literature.  In  what  follows  we  shall  select  for  illustration  only  those 
royal  families  the  physical  and  mental  characters  of  the  individuals 
of  which  are  known. 

EIGHTEENTH-DYNASTY   KINGS 

Queen  Aahotep  I,  the  heiress  of  the  royal  line  of  Hierakonpolis, 
married  first  a  man  (name  unknown)  who  was  certainly  her  brother, 
for  on  the  stele  of  Abydos,  put  up  in  honour  of  his  (and  his  wife's) 
grandmother,  Tetishera,  her  son  Ahmose  I  exclaims:  "I  it  is  who 
have  remembered  the  mother  of  my  mother  and  the  mother  of  my 
father,  Tetishera."4  The  queen's  second  husband  was  Seqenenra, 
who  was  a  relative,  and  perhaps  a  brother.  The  mummy  of  this 
slim  and  remarkably  muscular  king,  who  died  fighting  the  Hyksos, 
measured  1 .  702  m.  in  length,  and  the  cranium  is  o.  195  m.  long  and 
0.131  m.  broad.    The  portrait  of  Queen  Aahotep  I,  on  the  lid  of 

'  J.  Nietzold,  Die  Ehc  in  Agyplcn,  p.  13. 

3  Ibid.  3  Erman,  Life  in  Ancient  Egypt,  p.  153. 

*  Petrie,  A  History  of  Egypt,  I,  225. 


326         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

her  coffin  in  Cairo,  is  that  of  a  well-nourished  young  person  with 
good  features.     She  had  eleven  children  by  her  two  husbands.1 

Ahmose  I,  who  was  thus  the  son  of  an  incestuous  union,  married 
his  sister  or  half-sister,  Nefertari  (Figs,  i  and  2),  whose  wooden 
statuette  at  Turin  represents  a  buxom,  well-formed  woman,  with 
no  obvious  sign  of  degeneration.  After  reigning  for  twenty-five 
years  with  Ahmose  I,  she  acted  as  adviser  to  her  son,  Amenhotep  I, 
and  must  have  been  fairly  advanced  in  years  at  the  time  of  her 
death.  She  was  "the  first  of  those  queens  by  divine  right  who, 
scorning  the  inaction  of  the  harem,  took  on  themselves  the  right  to 
fulfil  the  active  duties  of  a  sovereign.  "2  After  her  death  the  people 
raised  her  to  divine  rank;  she,  together  with  her  son,  Amenhotep  I, 
sprung  from  the  marriage  with  her  brother,  were  regarded  as  spe- 
cially "gracious  and  helpful."  Her  name  was  put  on  the  same 
plane  as  those  of  the  great  gods,  and  she  was  worshipped  for  six 
hundred  years  after  her  death. 


?   =  Tetishera 

I 


I   =   Seqenenra  ( ?) 


I  I  I  I 

Kemose         Skhentnebra         Ahmose  I   =  Nefertari 


*  [In  this  and  the  following  tables  I  have  underlined  the  descendants  of  consanguineous  marriages 
with  a  full  line,  and  the  rulers  (who  succeeded  to  the  throne  for  the  most  part  by  right  of  marriage  witb 
their  sister-wives)  with  a  dotted  line. — Alice  Ruffer.] 

Ahmose  I,  her  brother  and  husband,  ascended  the  throne  about 
1580  B.C.,  when  Egypt  was  endeavouring  to  throw  off  the  yoke  of 
foreign  conquerors,  the  hated  Hyksos,  who  for  nearly  two  hundred 
years  had  ruled  the  country.  During  his  brilliant  reign  of  twenty- 
four  years  this  great  king  drove  the  aliens  out  of  Egypt,  and  by  care- 
fully protecting  the  frontier  made  a  new  invasion  extremely  difficult. 
He  thus  made  Egypt  a  strong  military  state  and  established  the 
dynasty  on  a  firm  footing.  His  successors  conquered  Syria  and 
held  it  for  several  generations  in  spite  of  the  repeated  risings  of  local 

1  Petrie,  Abydos,  III,  Plate  LII.  2  Ibid. 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  327 

chiefs.  Ahmose  also  began  the  restoration  of  the  buildings  of 
Upper  Egypt,  which  had  fallen  into  decay  under  the  Hyksos  rule. 
He  died  at  the  age  of  fifty-five.  His  mummy  measures  1 .  63  m.  in 
length.  The  face,  like  that  of  all  the  rulers  of  the  earlier  Eighteenth 
Dynasty,  is  comparatively  small,  the  nose  prominent,  though  in  the 
dried  body  this  organ  looks  small  and  narrow;  the  face  is  ovoid,  the 
chin  narrow,  the  superciliary  ridge  fairly  marked,  and  the  upper 
teeth  are  prominent  as  in  the  women  of  the  family  and  in  Thut- 
mose  II.  The  length  of  the  head  (including  wrappings)  is  o .  207  m., 
and  the  breadth  (without  wrappings),  o.  156  m. 

TABLE  II 

(Brother)   =  Aahotep  I   =   Seqenenra 
Ahmose     =     Nefertari 

1  1  rr      1  1  1 

Merytamen         Satamen         Sapair         Satkames         Amenhotep  I         Aahotep  II 

TABLE  III 
Brother  =  Aahotep  I   =   Seqenenra 

I  I 

Ahmose    =     Nefertari 

I  I 

Senseneb  =  Amenhotep  I   =  Aahotep  II 

I  1  1  1         n 

Thutmose  I     =     Aahmes         Nebta        Amenmes        Uazmes 


Amenhotep  I,  son  of  Ahmose  I,  reconquered  Nubia,  repelled  an 
attack  of  the  Libyans,  invaded  Syria,  and  reached  the  Euphrates. 
He  added  to  the  temple  of  Karnak  and  to  those  on  the  opposite  bank 
of  the  Nile.  The  divine  honours  which  were  paid  to  him  for  nigh 
six  hundred  years  after  his  death  bear  witness  to  the  strength  of  his 
personality  (Fig.  3).  He  reigned  twenty-one  years,  and  died  when 
fifty-six  years  old.1  His  mummy  in  the  Cairo  Museum,  not  yet 
unrolled,  is  that  of  a  short  man,  measuring  1 .65  m.  in  length. 

Of  his  sister  and  wife,  Aahotep  II,  little  is  known.  The  union 
brought  forth  four  children — two  sons,  Amenmes  and  Uazmes,2  and 

'  Pel  rie,  A  History  of  Egypt,  I,  54.  '  Buttles,  The  Queens  of  Egypt,  p.  71. 


328         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

two  daughters,  Aahmes  and  Nebta.  One  of  the  sons  was  associated 
for  a  time  with  his  father  in  governing  the  country.  One  daughter, 
Aahmes,  married  her  half-brother,  Thutmose  I,  the  son  of  her  father 
by  Senseneb,  probably  a  slave.  Her  portrait  adorns  the  walls  of  the 
temple  of  Deir  el  Bahri  (Fig.  5),  and  without  doubt  her  expression 
is  fascinating;  the  features  are  refined  and  it  would  be  difficult  to 
find  a  nobler  countenance  than  that  of  this  queen,  the  descendant 
of  incestuous  marriages  of  great-grandparents,  grandparents,  and 
parents.     The  length  of  her  life  is  unknown. 

Her  husband  and  half-brother,  Thutmose  I,  ascended  the  throne 
about  1535  B.C., led  an  expedition  into  Nubia,  forced  his  way  through 
the  Cataract,  and  seized  and  strongly  fortified  the  country.  He 
then  invaded  Syria  and  reached  Naharin,  that  is,  the  country  from 
the  Orontes  to  the  Euphrates  and  beyond,  where  he  slew  or  made 
prisoners  many  of  his  foes.  At  home  he  was  a  passionate  and 
successful  builder.  He  built  the  temple  of  Set  at  Nubt,  near 
Negadah,  the  great  temple  of  Medinet  Abou,  probably  designed  the 
temple  of  Deir  el  Bahri,  added  pylons  and  an  obelisk  to  the  temple 
of  Karnak,  and  protected  his  country  by  rebuilding  the  frontier 
defenses.  He  died  at  the  age  of  forty-eight,  after  celebrating  the 
thirtieth  anniversary  of  his  coronation. 

The  authenticity  of  the  mummy  (Fig.  4)  supposed  to  be  that  of 
Thutmose  I  is  not  quite  certain,  though  the  likeness  to  Thutmose  II 
leaves  little  doubt  that  this  mummy  is  that  of  Thutmose  I  or  some 
near  relative.  It  is  1 .  54  m.  long.  The  cranium  measures  0.18  by 
o.  133  m.,  and  the  narrow,  long,  refined  face  is  that  of  a  clever  and 
cunning  person. 

The  marriage  of  Aahmes  with  her  half-brother,  Thutmose  I,  had 
issue,  two  sons  and  two  daughters,  of  whom  both  boys  and  one 
daughter  died  young.  The  second  daughter,  Queen  Hatshepsut  I, 
in  spite  of  opposition,  was  associated  with  her  father  in  the  govern- 
ment of  the  kingdom.  Thutmose  I  had  married,  beside  Queen 
Aahmes,  a  woman  of  only  half-royal  lineage,  Mut-nefert;  and 
Hatshepsut,  following  the  royal  tradition,  married  her  half-brother, 
Thutmose  II,  born  from  the  latter  marriage. 

Thutmose  II  added  a  pylon  to  Karnak,  decorated  the  temple 
with  statues,  and  inscriptions  relating  to  his  work  are  met  with  as 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  329 

far  as  Barkal  in  the  Sudan  and  the  Oasis  of  Farafra.  The  mask, 
statues,  and  mummy  of  Thutmose  II  (Fig.  6)  represent  a  smiling 
and  amiable  countenance,  with  features  somewhat  weaker  than 
those  of  Thutmose  I,  whom  he  otherwise  resembles.  The  body  is 
thin,  somewhat  shrunken,  and  not  very  muscular,  and  measures 
1.684  m->  the  bald  head  being  o.  191  m.  long  by  o.  149  m.  broad, 
and  the  face  wrinkled. 

Thutmose's  half-sister  and  queen,  Hatshepsut,  proved  an 
exception  to  the  rule  that  the  female  members  of  the  family  inherited 
the  Egyptian  crown  but  exerted  no  authority,  for  she  overshadowed 
her  husband  and  was  the  actual  sovereign,  and  he  merely  the  king- 
consort.  She  "  acted  as  master  of  the  country.  The  kingdom  was 
subjected  to  her  will.     Egypt  bowed  its  head. "" 

TABLE  IV 

Senseneb  =  Amenhotep  I  =  Aahotep  II 

Mut-nefert  =  Thutmose  I    =    Aahmes 
Aset  =  Thutmose  II   =  Hatshepsut 
Thutmose  III    =    Merytra  Hatshepsut 

After  the  death  of  Thutmose  II,  the  queen,  according  to  the 
custom  of  the  country,  shared  the  kingdom  with  her  nearest  male 
relative,  Thutmose  III,  the  son  of  her  former  husband  by  Asat, 
who  apparently  was  not  of  royal  birth. 

To  strengthen  her  position,  the  queen  claimed  direct  descent 
from  the  god  Amon,  and  her  miraculous  conception,  birth,  and 
education  are  recorded  on  the  walls  of  the  Luxor  temple.  With 
remarkable  energy  she  restored  many  buildings,  built  the  temple  of 
Deir  el  Bahri,  began  the  fagade  at  Speos  Artemides,  brought  an 
obelisk  from  Nubia  to  Luxor,  and  fitted  out  an  expedition  to  the  land 
of  Punt,  which  returned  with  great  treasure,  quaint  animals,  and 
plants.  Her  reign  was  perhaps  too  peaceful,  as  it  was  probably 
during  this  period  that  some  of  the  Asiatic  provinces  were  lost  to 
Egypt.     A  wise  ruler,  she  exercised  her  power  with  justice  and 

'  Maspero,  The  Struggle  of  the  Nations,  p.  42. 


330         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

moderation  during  her  long  reign,  and  throughout  the  Nile  Valley, 
from  Buto  in  the  Delta,  by  way  of  Beni-Hassan,  Karnak  and  Thebes, 
El  Kab,  and  Kom  Ombo,  to  Assouan  at  the  First  Cataract  of  the 
Nile,  and  from  the  far  rock  cliffs  of  Sinai,  sculptured  stone  and 
inscribed  stele  record  the  reign  of  Hatshepsut,  fulfilling  the  wish 
voiced  in  her  temple  that  her  name  may  remain  and  live  on  in 
temple  and  land  for  "ever  and  ever."  Nothing,  unfortunately,  is 
known  about  her  personal  appearance,  as  the  Luxor  and  Deir  el 
Bahri  portraits  are  conventional  and  for  the  most  part  obliterated 
by  her  successors. 

No  less  remarkable  than  Hatshepsut  was  her  nephew  and  step- 
son, Thutmose  III,1  the  son  of  a  father  descended  from  a  series  of 
incestuous  marriages,  and  of  a  mother  who  was  not  of  royal  blood. 
After  Hatshepsut's  death  he  became  one  of  the  strongest  rulers  in 
Egyptian  history;  during  her  lifetime  his  influence  had  not  been 
felt.  His  Majesty  was  somewhat  short,  measuring  1.615  m.,  his 
cranium  was  o.  196  m.  long  and  o.  150  m.  broad,  and  though  he  died 
at  an  advanced  age  his  mummy  with  its  distinguished  features  gives, 
in  spite  of  the  bald  head,  the  impression  of  a  youngish  person.  The 
upper  teeth  project  greatly  (Fig.  7). 

His  character  stands  forth  with  more  of  colour  and  individuality  than 
that  of  any  king  of  early  Egypt,  except  Akhnaton.  We  see  the  man  of  a 
tireless  energy  unknown  in  any  Pharaoh  before  or  since,  the  man  of  versatility, 
designing  exquisite  vases  in  a  moment  of  leisure;  the  lynx-eyed  administrator, 
who  launched  his  armies  upon  Asia  with  one  hand  and  with  the  other  crushed 
the  extortionate  tax-gatherer.2 

Thutmose  III  left  his  mark  on  Heliopolis,  where  he  erected  the 
two  famous  obelisks,  on  Abu  Sir,  Memphis,  Gurob,  etc.  Koptos 
was  entirely  rebuilt,  Karnak  was  extended,  Medinet  Abou  and  Deir 
el  Bahri  were  completed,  more  than  thirty  different  sites  in  Egypt 
and  Nubia  were  built  over,  and  innumerable  fragments  of  statues, 
sphinxes,  etc.,  testify  to  the  building  activity  of  this  great  warrior. 

His  reign  marks  an  epoch  not  only  in  Egypt,  but  in  the  whole  East  as  we 
know  it  in  his  age.     Never  before  in  history  had  a  single  brain  wielded  the 

1  Thutmose  III  is  held  by  some  to  have  been  the  son  of  Thutmose  I  and  not  of 
Thutmose  II.  If  that  be  true,  he  married  not  his  sister  but  his  niece.  See  Petrie, 
A  History  of  Egypt,  II,  78. 

3  Breasted,  A  History  of  Egypt. 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  331 

resources  of  so  great  a  nation  and  wrought  them  into  such  centralized,  per- 
manent, and  at  the  same  time,  mobile  efficiency,  that  for  years. they  could  be 
brought  to  bear  with  incessant  impact  upon  another  continent  as  a  skilled 
artizan  manipulates  a  hundred-ton  forge  hammer;  although  that  figure  is 
inadequate  unless  we  remember  that  ThutmOse  forged  his  own  hammer.  The 
genius  which  rose  from  an  obscure  priestly  office  to  accomplish  this  for  the 
first  time  in  history  reminds  us  of  an  Alexander  or  of  a  Napoleon.  He  built 
the  first  real  empire,  and  is  thus  the  first,  character  possessed  of  universal 
aspects,  the  first  world  hero.  He  made  not;  only  a  world-wide  impression 
upon  his  age,  but  an  impression  of  a  new  order.  His  commanding  figure, 
towering  like  an  embodiment  of  righteous  penalty  among  the  trivial  plots  and 
treacherous  schemes  of  the  petty  Syrian  dynasts,  must  have  clarified  the 
atmosphere  of  Oriental  politics  as  a  strong  wind  drives  away  miasmic  vapours. 
The  inevitable  chastisement  of  his  strong  arm  was  held  in  awed  remembrance 
by  the  men  of  Naharin  for  three  generations.  His  name  was  one  to  conjure 
with,  and  centuries  after  his  empire  had  crumbled  to  pieces,  it  was  placed  on 
amulets  as  a  word  of  power.1 

He  died  at  the  age  of  sixty-three. 

Thutmose  III  married  his  half-sister,  Merytra  Hatshepsut, 
Queen  Hatshepsut's  daughter,  and  also  another  woman,  Sat-Aah. 
The  number  of  his  children  is  unknown,  but  he  is  said  to  have  had 
eight  daughters. 

Amenhotep  II,  the  son  of  Thutmose  III  and  Merytra  Hatshepsut, 
was  1 .  63  m.  in  height.  He  was  associated  with  his  father  in  govern- 
ment for  some  time,  and  ascended  the  throne  when  about  eighteen 
to  twenty  years  old,  reigned  for  twenty-five  years,  and  died  at  the 
age  of  forty-six.  His  physical  strength  was  extraordinary,  and  he 
claimed  that  no  one  could  bend  his  bow  (Fig.  8). 

On  the  death  of  Thutmose  III,  the  Syrian  tribes  almost  simul- 
taneously rose  in  revolt,  but  they  had  not  reckoned  with  the  bound- 
less energy  of  the  new  king.  Amenhotep  II  left  Egypt  with  his 
army  in  April  and  already  in  May  defeated  the  Syrians  in  a  battle 
in  which  he  with  his  own  hand  took  eighteen  prisoners  and  fifteen 
horses.  He  advanced  with  irresistible  power,  crossed  the  Euphrates 
triumphantly,  returned  to  Egypt,  and,  equally  successful  in  the 
South,  conquered  part  of  the  Sudan. 

Amenhotep  II  married  Tiaa,2  who  may  have  been  his  half-sister 
by  a  mother  not  of  royal  birth.     Their  son,  Thutmose  IV  (Fig.  9), 

1  Breasted,  op,  cil.  *  Buttles,  op.  cit.,  p.  101. 


332         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

an  energetic  lion-hunter  in  his  youth,  came  to  the  throne  at  the  age 
of  twenty-four,  and  showed  his  energy  by  leading  an  expedition  to 
Syria,  from  which  he  returned  with  a  cargo  of  cedar  and  many 
prisoners.  He  contracted  an  alliance  with  Babylonia  and  with 
the  Mitannian  king,  whose  daughter,  Mutemuya,1  he  married. 
He  died  at  the  age  of  thirty-three. 

Thutmose  IV  was  followed  by  his  sixteen-year-old  son,  Amenho- 
tep  III,  who  married  the  celebrated  Tiy  (Fig.  1 1),  a  woman  of  uncer- 
tain origin,  perhaps  a  Syrian  princess  of  partly  Egyptian  descent,  and 
also  another  Syrian  princess,  Kirgipa  or  Gilukhipa.  The  reign  of 
this  king  was  marked  by  great  expansion  of  art  and  commerce  due 
to  peaceful  development  at  home  rather  than  by  great  conquests. 
He  reigned  for  thirty-six  years  and  died  when  about  fifty-two  years 
old  (Fig.  10).  Owing  to  their  shorter  reigns,  Amenhotep  II,  Thut- 
mose IV,  and  Amenhotep  III  built  far  less  than  their  predecessors. 

Amenhotep  IV  (Figs.  12  and  13),  or  Akhnaton,  the  last  king  of 
this  dynasty  to  play  a  leading  part  in  history,  was  the  grandson  of 
Mutemuya,  a  Syrian  woman,  and  the  son  of  Tiy,  whose  nationality, 
as  just  said,  is  uncertain,  and  his  peculiar  genius,  therefore,  may 
have  been  due  to  the  foreign  blood  in  his  veins  or  to  the  powerful 
influence  exerted  on  him  by  his  mother. 

The  characteristic  traits  of  Akhnaton  were  religious  enthusiasm 
and  a  high  moral  standard.  As  Weigall  has  pointed  out,  he  was  the 
first  Egyptian  monotheist2  and  monogamist  at  a  time  when  poly- 
theism and  polygamy  were  the  fashion,  and  a  pacifist  when  Egyp- 
tians were  enjoying  the  fruits  of  their  conquests.  He  erected  an 
entirely  new  town,  Akhetaton,  now  Tell  el  Amarna,  which  he 
adorned  with  the  temples  of  Queen  Tiy,  of  Baketaton,  the  king's 
sister,  of  Queen  Nefertiti,  and  last,  but  most  important  of  all,  with 
the  great  temple  of  Aton.  An  intellectuel  of  the  first  order,  he 
patronized  a  new  and  realistic  form  of  art,  but  his  fanatical  hatred 
of  the  ancient  religion  led  to  the  destruction  or  mutilation  of  count- 
less ancient  artistic  treasures,  and  his  neglect  of  the  royal  duties, 
his  inertia  and  physical  laziness  brought  about  the  loss  of  the  Syrian 
kingdom.  In  truth,  he  showed  in  some  of  his  actions  as  little 
common  sense  as  some  other  religious  reformers  have  done.     Never- 

'  Breasted,  op.  cit.,  p.  328.  2  Weigall,  Akhnaton. 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  333 

theless,  a  monarch  who  founds  a  monotheistic  religion  in  the  teeth 
of  the  opposition  of  a  most  powerful  priesthood,  who  builds  a  new 
town  where  he  worships  his  god  away  from  old  associations  and 
among  congenial  surroundings,  who  endows  that  new  town  with 
beautiful  temples,  who  patronizes  a  new  form  of  art,  and  who  per- 
haps composed  the  magnificent  hymn  to  Aton,  cannot  be  considered 
as  lacking  in  energy,  or  as  a  degenerate,  or  an  effeminate  person 
(Fig.  14). 

The  characteristics  of  the  Eighteenth  Dynasty  were  thus  tireless 
energy,  which  enabled  Egypt  to  resist  its  foreign  foes,  to  carry  the 
Egyptian  flag  abroad,  and  to  establish  wise  government  at  home, 
and  an  enlightened  taste  for  the  fine  arts  most  forcibly  shown  in  the 

TABLE  V 
Merytra  Hatshepsut   =  Thutmose  III 


Amenhotep  II  =  Tiaa 

Thutmose  IV  =  Mutemuya 

Amenhotep  III  =  Tiy 

Amenhotep  IV  (Akhnaton) 

artistic  reforms  of  Akhnaton.  In  these  nine  generations,  issued 
from  consanguineous  marriages,  there  is  no  diminution  of  mental 
force.  The  energy  characteristic  of  Ahmose  I  is  found  two  hundred 
years  afterwards  in  Akhnaton,  used,  it  is  true,  for  different  objects 
and  higher  ideals,  but  as  intense  in  i375-i358asitwasin  1580-1557. 
Akhnaton's  ideal  may  have  been  suggested  by  his  mother,  the  clever 
queen  Tiy;  his  energy  and  keen  intellect  he  inherited,  in  part,  at 
least,  from  his  father. 

In  the  absence  of  any  data  regarding  the  average  number  of 
children  in  Egyptian  families,  it  is  not  possible  to  compare  accurately 
the  fertility  of  the  consanguineous  unions  of  the  Eighteenth  Dynasty 
with  that  of  unrelated  people  from  the  same  period;  all  that  can  be 
said  is  that  without  doubt  these  incestuous  unions  were  blessed  with 
many  children.     Moreover,  the  sexual  power  of  the  male  members 


334         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

of  the  family  is  proved  by  the  fact  that  they  had  families  by  their 
sisters,  wives,  and  by  other  women  as  well.  Table  VI,  giving  the 
children  known  to  have  been  born  to  the  kings  and  queens  of  this 
dynasty,  is  necessarily  incomplete,  as  the  number  of  children  born 
in  and  out  of  wedlock  cannot  even  be  guessed  at,  and  indeed  many 
of  those  mentioned  in  the  table  would  have  been  entirely  forgotten 

TABLE  VI 
Eighteenth-Dynasty  Kings 
A  brother  =  Queen  Aahotep  I  =  Seqenenra  (a  brother  ?) 


I  I  I  I 

Kemose        Skhentnebra        Ahmose  =  Nefertari 


i  i       r      i         i  i  i 

Merytamen  Satamen  Sapair  Satkames  Senseneb  =  Amenhotep  I  =  Aahotep  II 


I  I         I         F~ 

Mutnefert  =  Thutmose  I  =  Aahmes  Nebta  Amenmes  Uazmes 


Aset  =  Thutmose  II  =  Hatshepsut 
Thutmose  HI  =  Merytra  Hatshepsut 

Amenhotep  II  =  Tiaa  (half-sister  ?) 
Mutumaya  =  Thutmose  IV 
Amenhotep  III  =  Tiy 
(Akhnaton)  Amenhotep  IV  =  Nefertiti 

had  it  not  been  for  the  accidental  discovery  of  some  document  or 
object  inscribed  with  their  names.  The  infants  who  died,  the  mis- 
carriages, and  the  illegitimate  children,  etc.,  must  remain  an  un- 
known quantity,  though  it  can  be  asserted  that  the  number  of 
children  born  was  certainly  larger  than  that  given  in  this  table.  In 
the  case  of  the  Eighteenth  Dynasty,  therefore,  loss  of  prolificity  did 
not  follow  consanguineous  marriages. 

The  second  evil  usually  attributed  to  consanguineous  marriages 
is  diminished    duration    of    life    in    the    offspring.     The    figures 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES 


335 


referring  to  this  point  given  in  Table  VII  are  approximate  only, 
for  some  monarchs  may  have  lived  a  few  years  more  or  less;  and 
further,  as  the  mean  duration  of  life  in  ancient  Egypt  is  unknown, 
the  value  of  the  table  is  diminished;  but  in  any  case,  an  average 
duration  of  life  of  forty-four  years  cannot  be  considered  as  short. 


Ahmose  I 

Amenhotep  I.  . 
Thutmose  I .  .  . 
Thutmose  III . 
Amenhotep  II. 
Thutmose  IV. . 
Amenhotep  III 
Amenhotep  IV 


Reign 


1580-1557 
}  IS57-I50I 
ISOI-1447 
1448-1420 
1420-1411 
1411-1375 
1375-1358 


Age  at  Death 


TABLE  VIII 


Cranial  Measurements 


Ahmose 

Amenhotep  I .  . 
Thutmose  I.  .  . 
Thutmose  II.  . 
Thutmose  III . 
Amenhotep  II . 
Thutmose  IV. . 
Amenhotep  III 
Amenhotep  IV . 


1.63 
1-65 
i-54 
1.685 
1. 61 
1.67 
1.65 
1-56 
mummy 
incomplete 


.191 
.  196 
.191 
.184 
.194 


156 


There  is  no  evidence  to  show  that  idiocy,  deaf-mutism,  or  other 
diseases  generally  attributed  to  consanguineous  marriage  ever 
occurred  among  the  members  of  this  dynasty,  and  as  far  as  can  be 
ascertained  from  mummified  bodies,  masks,  and  statues,  the  fea- 
tures of  both  men  and  women  were  fine,  distinguished,  and  hand- 
some. 

The  heights  and  cranial  circumferences  are  shown  in  Table  VIII. 
The  kings,  though  not  tall  men,  were  by  no  means  undersized,  and 
their  height  is  well  maintained  during  nine  successive  generations. 


336         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

The  cranial  measurements  of  413  living  modern  Egyptians1  give  an 
average  of  0.184  by  0.133  m->  which  almost  exactly  corresponds 
with  the  cranial  measurements  of  Thutmose  I. 

The  portraits  and  mummies  are  those  of  stout,  well-nourished 
persons.  Although  the  mummified  body  of  Thutmose  II,  for 
instance,  is  now  reduced  to  little  more  than  skin  and  bone,  the 
redundancy  of  the  skin  of  the  abdomen,  thighs,  and  cheeks  is  a 
proof  of  the  obesity  of  the  king.  Perhaps  the  most  typical  instance 
of  pathological  obesity  in  the  family  is  seen  in  the  portraits  of  the 
heretic  king  Akhnaton  (1374-1356  B.C.)  who  is  represented  as  a  man 
with  a  thin  face,  neck,  and  legs,  but  with  a  very  protuberant 
abdomen.  There  is  no  reason  to  doubt  that  the  portraits  of  the 
monarch  are  faithful  likenesses.  True,  the  abdomen  is  rather  promi- 
nent in  other  people  represented  at  Tell  el  Amarna,  owing  chiefly 
to  the  cut  of  the  dress,  which,  firmly  tied  below  the  umbilicus,  caused 
the  lower  part  of  the  abdomen  to  protrude;  but  in  persons  not 
wearing  this  dress  the  abdomen  is  flat,  and  even  in  men  attired  in 
the  garment  just  described  it  is  never  as  protuberant  as  in  King 
Akhnaton.  Where  the  king  is  represented  distributing  collars  of 
gold,  his  abdomen  actually  hangs  over  the  edge  of  the  balcony,  a 
most  realistic  piece  of  portraiture.  The  very  thin  calves  of  Akhna- 
ton show  that  the  artist  faithfully  copied  nature.  The  king's 
obesity  may  have  been  partially  responsible  for  his  politics.  Corpu- 
lent subjects  generally  dislike  physical  exertion,  and  his  stoutness 
may  have  been  the  reason  why,  when  the  outlying  provinces  of  his 
kingdom  were  threatened,  he  left  unanswered  the  appeals  for  help 
and  thus  became  responsible  for  the  loss  of  some  of  the  foreign 
possessions  of  Egypt.  Another  picture  from  Tell  el  Amarna  may 
be  referred  to  here.2  It  is  divided  into  two  halves,  the  left  repre- 
senting the  household  of  Akhnaton,  the  right  the  household  of  his 
father,  Amenhotep  III.  It  shows  that  Akhnaton's  obesity  was 
inherited,  for  father  and  son  show  the  same  abdominal  deformity. 
Indeed,  the  whole  royal  family  is  distinctly  stout,  in  contrast  with 
the  three  lean  female  servants  on  the  extreme  right.  The  mummy 
of  Amenhotep  III  (1411-1375  b.c.)  is  in  the  Cairo  Museum,  and  it 

1  Archaeological  Survey,  p.  25. 
*  El  Amarna,  i,  ii,  xviii. 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  337 

is  unfortunate  that  the  body  is  in  such  a  wretched  state  that  its 
examination  gives  little  information  as  to  his  corpulency. 

The  skull  attributed  to  Akhnaton,  according  to  Elliot  Smith, 
presents  a  number  of  interesting  and  significant  features.  The 
cranium  is  broad  and  relatively  flattened,  its  measurements  being 
0.189  m.  in  length  and  0.154  m.  in  breadth,  0.136  m.  in  height, 
0.099  m-  minimal  frontal  breadth,  with  a  circumference  of  o.  545  m. 
The  form  of  the  cranium,  and  the  fact  that  it  is  exceptionally  thin 
in  some  places  and  relatively  thick  in  others,  indicate,  in  Elliot 
Smith's  opinion,  that  a  condition  of  hydrocephalus  was  present 
during  life;  and  Professor  A.  R.  Ferguson  is  of  the  opinion  that  the 
signs  of  this  disease  are  unquestionable.  Whether  the  skull  is  Akh- 
naton's  or  not,  it  is  interesting  to  find  that  hydrocephalus  existed 
about  thirty-five  hundred  years  ago. 

The  result  of  this  inquiry  is  that  a  royal  family,  in  which  con- 
sanguineous marriage  was  the  rule,  produced  nine  distinguished 
rulers,  among  whom  were  Ahmose,  the  liberator  of  his  country; 
Thutmose  III,  one  of  the  greatest  conquerors  and  administrators 
that  the  world  has  ever  seen;  Amenhotep  IV,  the  fearless  religious 
reformer;  the  beloved  queen  Nefertari  who  was  placed  among  the 
gods  after  her  death;  Aahmes,  the  beautiful  queen,  and  Hatshepsut, 
the  greatest  queen  of  Egypt.  There  is  no  evidence  that  the  physical 
characteristics  or  mental  power  of  the  family  were  unfavourably 
influenced  by  the  repeated  consanguineous  marriages. 

NINETEENTH-DYNASTY   KINGS 

The  kings  and  queens  of  the  Nineteenth  Dynasty,  a  remarkably 
handsome  set  of  people,  were  probably  lineal  descendants  of  those  of 
the  Eighteenth  Dynasty. 

Seti  I  (Figs.  15  and  16),  in  spite  of  his  big  and  heavy  jaw,  pre- 
sents a  most  noble  and  dignified  appearance;  he  measures  1 .665  m. 
in  height,  and  his  cranium  0.196  by  0.143  m.  Ramses  II  (Fig.  17), 
the  great  historical  figure  of  this  dynasty,  married  two  of  his  sisters, 
and  had  four  children  by  the  first,  and  three,  or  possibly  four,  by 
the  second  sister.  He  is  said  to  have  married  two  of  his  daughters, 
but  the  evidence  on  this  point  is  not  conclusive.  By  other  wives 
and  concubines  the  king  is  said  to  have  had  one  hundred  six  other 


338 


STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 


sons  and  forty-seven  daughters,  therefore  this  descendant  of  a  long 
line  of  consanguineous  marriages  cannot  be  said  to  have  been 
infertile.  His  features  are  strong  and  refined,  the  teeth  excellent, 
and  the  only  blemish  is  the  complete  baldness.  The  body  measures 
i .  733  m.,  and  his  cranium  o .  195  by  o .  136  m.  (Fig.  18). 

Little  is  known  about  Ramses  II's  children  (Fig.  20).  One  son, 
Khemwese,  became  high  priest  of  Ptah,  organized  the  thirtieth 
anniversary  of  his  father's  reign,  was  associated  with  the  king  in  the 

TABLE  IX 

Nineteenth-Dynasty  Kings 

Setil  =  Tuaa 

I  I  I  I 

Two  sons     Astnefcrl  T  =  Ramses  II  =  Ncfertari-mery-mut 

I                    I                    I                    I                             I  I  i  1       . 

Benanta  Khaemuas  Ramses   Astnefert  II  =  Merneptah    Merytamen    Nebenkharu   Nebtani 
(Khemwese)  ^^^^^^^  1    

Seti  II  =  Takhat,  a  daughter  of  Ramses  II 

Amenmeses 

Seti  II  had  by  an  Seti  II  had  by  an 

unknown  wife  unknown  wife 

I  , I , 

Setnekht 

I  Sephthah   =  Tausert 

Ramses  III  rrrrrrrrrf        rrr^^ 

both  of  whom  reigned 

I  I 

Ramses  IV         Ramses  VI 


administration  of  Egypt,  and  predeceased  his  father.  The  other 
children  formed  the  powerful  tribe  of  the  Ramessides,  which  exerted 
considerable  influence  f6r  many  generations;  one  daughter,  Ben- 
anta, was  charmingly  pretty. 

Merneptah  (Fig.  19),  the  son  of  Ramses  II  by  his  first  sister,  was 
more  than  middle-aged  when  he  succeeded  his  father,  and  he,  in 
spite  of  his  years,  dealt  energetically  with  the  foes  of  Egypt. 
When  the  Libyans  threatened  the  very  existence  of  Egypt,  he 
assembled  his  nobles,  stirred  up  their  enthusiasm  by  an  eloquent 
speech,  and  with  their  help  inflicted  a  crushing  defeat  on  the 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES 


339 


Libyans  and  their  European  mercenaries.  Turning  then  to  Pal- 
estine, he  subdued  the  country  and  levied  tribute  on  the  land. 
"All  lands  are  united,  they  are  pacified.  Every  one  that  is  turbu- 
lent is  bound  by  King  Merneptah. " 


Height 

Cranial  Measurements 

Seti  I 

1 .665  m. 
1-733™- 
i .  714  m. 
1 .640  m. 
1.638  m. 

0. 196  m.  by  0. 143  m. 
0. 19s  m.  by  0. 136  m. 

Seti  II    .                

0. 189  m.  by  0, 147  m. 

*  King  Sephtah  suSered  from  left  talipes  equino-varus. 

Merneptah's  building  activities  were  not  great,  and  his  method 
of  obtaining  stone  by  breaking  up  ancient  monuments,  though 
closely  imitated  afterwards  by  Mehemet  Aly  and  in  still  more  recent 

TABLE  XI 

Twenty-first  Dynasty,  Ramesside  Line 


Of  Thebes 


Of  Tanis 


Herhor  =  Nezemt  ( ?) 


Nebseni   =   Thentamen   =   Nesibanebdadu 


I 
18  princes 


19  princesses 


Piankhi  =  Hent-taui  I     Pasebkhanu  I  (  ?) 


Pinezem  I   =   Maatkara 


. 1    Masaherta 

H  1 

.Minkheperra  =  Astemkheb  I 


I :  I 

Hent-taui  II  (2)  =  Tahenthuti  (1)  =  Nasibadadu 


Nesikhonsu    =    Pinezem  II    =    Astemkheb  II 


Nesitanebasheru 


times  by  British  administrators,  is  not  to  be  commended.  He  died 
after  a  reign  of  ten  years,  when  approximately  seventy  years  old, 
and   is  probably  the  Pharaoh  of  the  Exodus,  commonly  believed 


340         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

to  have  been  drowned  in  the  Red  Sea.  His  mummy  measures 
1.714  m.,  his  cranium  0.185  by  0.160  m.  The  aorta  was  cal- 
careous. 

Merneptah  married  As  tnefert  II,  most  probably  his  sister.  Their 
son  and  successor,  Seti  II  (Fig.  21)  died  (murdered?)  after  a  very 
short  reign,  during  which  he  carried  out  many  important  public 
works.  He  was  probably  fairly  advanced  in  years  at  the  time  of 
his  death. 

The  heights  and  cranial  measurements  of  the  Ramessides  are 
shown  in  Table  X. 

Table  XI  gives  a  resume  of  the  chief  marriages  of  the  Twenty- 
first  Dynasty,  and  shows  that  consanguineous  marriages  were 
Common,  and  marriages  between  brother  and  sister  very  few. 

King  Herhor  married  Nezemt,  who  was  probably  a  near  relative 
and  possibly  his  sister,  and  at  Karnak  she  is  represented  at  the  head 
of  a  long  list  of  her  children,  eighteen  princes  and  nineteen  princesses. 
The  grandson  Pinezem  I  reigned  over  forty  years,  but  very  little  is 
known  about  the  rest  of  the  family. 

ETHIOPIAN   KINGS 

The  Ethiopian  Dynasty  also  followed  the  custom  of  close  inter- 
marriage. Queen  Amenertas  married  her  brother  Piankhi  II,  and 
their  daughter  Shepenapt  III  married  her  half-brother  Taharka,  the 

TABLE  XII 

Shepenapt  II  =  Kashta 


Amenertas    =    Piankhi    =    Akalouka 
Shepenapt  III  =  Taharka 
Amenertas  II 

son  of  Akalouka,  and  a  child,  Amenertas  II  (and  possibly  others) 
was  born  from  this  consanguineous  marriage.  Taharka  was  a  man 
of  foresight,  power,  and  courage,  but  unfortunately  we  know  prac- 
tically nothing  of  Amenertas  II. 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  341 

PTOLEMAIC    KINGS 
I.      DIRECT   LINE 

The  history  of  the  Ptolemies  is  of  special  interest  to  the  student 
of  heredity,  because  the  first  four  kings  of  the  family  not  sprung 
from  consanguineous  unions,  can  be  compared  with  the  later  kings 
who  were  born  when  such  marriages  had  become  the  rule. 

The  founder  of  the  dynasty,  Ptolemy  I  Soter  I  (Fig.  27,  1),  a 
favourite  general  and  companion  of  Alexander  the  Great,  enjoyed 
so  great  a  popularity  and  influence  that  at  the  death  of  Alexander 
the  satrapy  of  Egypt  fell  to  him  without  any  opposition,  and  he  lost 
no  time  in  establishing  himself  firmly  in  his  new  government.  He 
first  guarded  himself  against  an  attack  from  the  west  by  occupying 
Cyrene,  which  became  a  province  of  Egypt,  murdered  Cleomenes, 
the  financial  controller  who  had  been  appointed  by  Alexander  the 
Great,  defeated  the  regent,  Perdiccas,  who  had  marched  against 
Egypt,  and  put  him  to  death. 

At  the  second  settlement  of  the  empire  (321  B.C.),  Ptolemy  was 
again  awarded  Egypt,  with  whatever  lands  he  could  conquer  to  the 
west.  He  seized  both  Cyprus  and  Syria,  but  he  evacuated  the  last 
province  temporarily,  as  his  large  army  and  the  powerful  fleet  he 
had  equipped  were  only  just  strong  enough  to  rule  and  defend  Egypt, 
Cyrene,  and  Cyprus.  Indeed,  Ptolemy  was  averse  to  any  increased 
responsibility  unless  quite  sure  of  his  ground,  and  hence  he  pru- 
dently declined  the  royal  dignity  which  some  of  his  followers 
endeavoured  to  thrust  upon  him  until  the  death  of  the  sons  of 
Alexander  the  Great  had  removed  the  only  legitimate  claimants  to 
the  throne. 

The  fleet  and  fortifications  secured  Egypt  against  every  attempt 
at  invasion  from  the  eastern  frontier.  The  strength  of  the  Egyptian 
preparations  was  demonstrated  when  the  attack  of  Antigonus  by 
land  and  by  sea  failed  to  reach  Alexandria,  and  the  would-be  invader 
finally  asked  for  peace.  Later  on,  Antigonus  and  Demetrius  were 
defeated  by  the  great  coalition,  and  then  Ptolemy  who,  it  must  be 
confessed,  had  been  but  a  lukewarm  supporter  of  the  allies,  secured 
lower  Syria  and  Phoenicia  as  his  share  of  the  plunder.  Shortly 
afterwards,  the  reoccupation  of  Cyprus,  which  he  had  given  up 


342         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

temporarily,  his  appointment  as  protector  of  the  league  of  free  cities 
on  the  coast  and  islands  of  Asia  Minor,  and  his  settlements  on  the 
coasts  of  the  Red  Sea  gave  him,  backed  by  his  fleets,  the  command 
of  the  sea. 

At  home,  the  relations  between  the  king  and  the  native  Egyptian 
population  were  so  friendly  that  the  latter  gladly  enlisted  under 
Ptolemy's  banner,  and  the  large  turbulent  population  of  natives, 
Greeks, Persians,  Syrians,  etc.,  was  kept  well  in  hand.  Ptolemy  suc- 
ceeded— and  that  was  perhaps  his  most  wonderful  achievement — - 
in  founding  in  Egypt  the  cult  of  Serapis,  a  divinity  adored  by  both 
Greeks  and  natives.  Science  and  art  were  encouraged,  the  cele- 
brated Museum  was  founded,  Alexandria  became  the  great  scientific 
centre  of  the  world,  trade  was  encouraged,  agriculture  developed, 
exchange  made  easier  by  the  new  coinage,  and  every  department  of 
state  was  improved  by  the  new  ruler. 

Ptolemy  abdicated  in  285  B.C.  and  died  two  years  afterwards  at 
the  age  of  eighty-four.  He  had  married,  probably  at  Alexander's 
instigation,  a  Persian  princess,  Artakama,  about  whom  nothing  is 
known.  Far  more  celebrated  than  this  first  wife  was  his  mistress, 
Thais,  the  courtesan,  who  had  at  least  two  children  by  him.  His 
second  legimate  wife  was  Euridike,  the  daughter  of  Antipater,  and 
by  her  he  also  had  several  children.  His  third  wife,  Berenike  I, 
a  grandniece  of  Antipater,  supposed  without  any  reason  to  have 
been  Ptolemy's  step-sister,  was  the  mother  of  several  children  by 
another  husband  at  the  time,  of  her  marriage  with  the  king.  Her 
influence  over  him  was  so  great  that  she  persuaded  him  to  put  aside 
Euridike's  son  and  to  adopt  her  own  son  as  his  heir.  Several  other 
children  were  born,  and  the  king  added  to  his  family,  already  very 
large,  by  adopting  all  his  step-children.  Divorce  from  his  second 
wife  is  nowhere  mentioned,  and  Ptolemy  was  doubtless  living  with 
both  his  second  and  third  wife  at  the  same  time. 

The  bold  and  patient  father  of  the  Ptolemaic  dynasty  was  a 
political  genius  of  the  first  order,  a  great  soldier,  a  cunning  diplomat, 
an  able  financier,  a  promoter  of  exploration,  a  master  of  foreign  and 
home  affairs,  a  religious  reformer,  and  a  protector  of  art,  science, 
commerce,  and  agriculture.  His  private  life,  on  the  other  hand, 
judged  by  our  present  standard,  was  far  from  edifying. 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  343 

Ptolemy  II  Philadelphia  (born  309,  died  246)  (Fig.  24),  son  of  the 
first  king,  married  Arsinoe'  I  (Fig.  25),  the  daughter  of  the  king  of 
Thrace,  and  later  on  his  own  sister,  older  than  himself,  by  whom  he 
had  no  issue.  His  character,  like  his  father's,  was  bold  and  cunning, 
and  again  like  his  father,  he  had,  in  spite  of  his  devotion  to  his  sister, 
many  mistresses:1  Didgona,  a  native  of  Egypt,  Bilisticha,  Agatho- 
clea,  Stratonike,  Clio,  his  cup-bearer,  who  clothed  in  a  tunic  only 
and  holding  a  cornucopia  in  her  hand,  was  represented  in  many 
statues,  to  the  scandal  even  of  Alexandria,  Myrtium,  a  most 
notorious  and  common  prostitute  who  owned  the  finest  houses  in 
Alexandria,  Mnesis  and  Pothina  the  flute-player,  and  many  others. 
His  effigies  on  the  coins  of  the  period  show  a  stout,  plethoric  man 
(Fig.  27,  7)  with  rather  fine  classical  features,  and  his  sister,  Arsinoe 
Philadelphus  (Fig.  27,  8),  looks  a  buxom,  handsome  woman  with 
regular  features.  The  king  died  at  the  age  of  sixty-three,  after 
having  been  a  martyr  to  gout. 

To  look  upon  Ptolemy  II  as  a  common  debauchee  is  doing  him  a 
great  injustice.  He  patronised  science  and  art,  subsidised  the 
Museum  and  added  considerably  to  the  library,  which  owned  the 
unprecedented  number  of  400,000  volumes.  The  famous  Septua- 
gint  version  of  the  Bible  possibly  dates  from  this  time.  His  foreign 
politics  were  successful,  and  at  home  his  reign  appears  to  have  been 
peaceful. 

Allowing  for  all  exaggeration,  the  "Praise  of  Ptolemy"  by 
Theocritus  shows  in  what  esteem  he  was  held  by  his  contemporaries : 

That  king  surpassingly  is  excellent 

For  wealth,  wide  rule  by  sea  and  o'er  much  continent. 

In  many  a  region  many  a  tribe  doth  till 

The  fields,  made  fruitful  by  the  shower  of  Zeus; 

None  like  low-lying  Egypt  doth  fulfil 

Hope  of  increase,  when  Nile  the  clod  doth  loose, 

O'er-bubbling  the  wet  soil:  no  land  doth  use 

So  many  workmen  of  all  sorts,  enrolled 

In  cities  of  such  multitude  profuse, 

More  than  three  myriads,  as  a  single  fold 

L'nder  the  watchful  sway  of  Ptolemy  the  bold. 

'  Athenacus  Dcipnosophisls  xiii.  40. 


344         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Part  of  Phoenicia,  some  Arabian  lands, 

Some  Syrian,  tribes  of  swart  Aethiopes, 

All  the  Pamphylians,  Lycians  he  commands, 

And  warlike  Carians;  o'er  the  Cyclades 

His  empire  spreads;  his  navies  sweep  the  seas; 

Ocean  and  rivers,  earth  within  her  bounds 

Obeys  him:   and  a  host  of  chivalries, 

And  shielded  infantry,  with  martial  sounds 

Of  their  far-glittering  brass,  the  warrior-king  surrounds. 

For  o'er  the  broad  lands  of  that  happy  sept 
The  bright-haired  Ptolemy  strict  ward  hath  kept. 

His  whole  inheritance  he  cares  to  keep, 
As  a  good  king.     Himself  hath  garnered  more: 
Nor  useless  in  his  house  the  golden  heap, 
Increased  like  that  of  ants. 

[Theocritus  Idylls,  xvii] 

The  third  Ptolemy,  Euergetes  I  (Fig.  27,  2),  married  Berenike  of 
Cyrene  (Fig.  27,  3).  He  was  a  successful  warrior  and  diplomatist, 
and  a  patron  of  science  and  religion.  The  Museum  and  Library 
continued  to  flourish  under  his  reign;  he  invited  great  savants, 
including  Eratosthenes,  to  settle  in  Egypt,  reformed  the  calendar, 
and  built  the  temple  of  Edfou.  Of  all  the  Ptolemies,  he  was  the 
only  one  whose  private  life  was  exemplary.  He  died  when  about 
sixty- three  years  old.  Physically,  there  was  a  great  resemblance 
between  him  and  his  father. 

Ptolemy  IV  Philopator  (Fig.  27,  4),  the  son  of  Ptolemy  III  by  a 
princess  of  Cyrene,  succeeded  his  father,  and  his  life  is  of  great 
interest,  for  had  he  been  the  child  of  a  consanguineous  marriage,  his 
shameful  characteristics  would  doubtless  have  been  attributed  to 
the  close  relationship  between  the  parents. 

The  king  succeeded, 

in  the  heyday  of  youth,  with  his  education  completed  by  the  greatest  masters, 
to  a  great  empire,  a  full  treasury,  and  peace  at  home  and  abroad.  Yet,  in 
the  opinion  of  our  Greek  authorities,  Polybius  and  Strabo,  no  member  of  the 
dynasty  was  more  criminally  worthless,  nor  so  fatal  to  the  greatness  and 
prosperity  of  Egypt.1 

1  Mahaffy,  A  History  of  Egypt:  Ptolemaic  Dynasty,  p.  127. 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  345 

Shortly  after  his  ascent  to  the  throne,  the  queen-mother  Bere- 
nike  and  his  brother  Magas  were  murdered.  Whether  Ptolemy  IV 
had  a  share  in  planning  these  murders  is  uncertain,  but  undoubtedly 
the  fact  that  Sosibius,  the  chief  actor,  had  considerable  influence  on 
the  king  threw  some  suspicion  on  the  latter.  His  debauchery 
shocked  his  contemporaries.  He  loved  to  surround  himself  with 
low  courtesans  who  treated  him  with  scant  respect,  and  his  Greek 
mistress,  Agathoclea,  and  her  brother  Agathocles,  at  one  time  the 
real  rulers  of  the  country,  prevented  him  from  taking  a  legitimate 
wife  until  the  mistress  had  given  up  all  hopes  of  having  a  child.  So 
great  was  this  woman's  influence  over  him  that  Strabo  simply  calls 
him  "Philopator,  he  of  Agathoclea."  Finally  he  married  his  sis- 
ter, Arsinoe  III  (Fig.  27,  5),  who  was  afterwards  murdered  by 
Agathocles. 

The  disreputable  private  life  of  Ptolemy  IV  did  not  inteifere 
with  his  considerable  diplomatic  ingenuity,  administrative  skill, 
and  military  efficiency.  On  Antiochus  attacking  Egypt,  an  army 
was  quickly  raised,  and  the  king,  accompanied  by  his  sister  Arsinoe, 
defeated  his  foe  at  Rapha,  and  this  victory  and  his  strong  govern- 
ment so  impressed  his  neighbours  that,  during  his  lifetime,  Egypt 
was  not  attacked  again.  In  spite  of  his  debauchery,  he  interested 
himself  in  intellectual  pursuits,  wrote  tragedies,  added  to  Philae, 
to  Ar-hes-Nefer,1  and  built  temples  at  Edfou,  Alexandria,  and  prob- 
ably at  Naucratis  also.  His  handling  of  home  affairs,  on  the  other 
hand,  was  not  altogether  successful;  rebellion  in  Lower  Egypt  had 
to  be  quelled,  and  at  the  time  of  his  death  Egypt  and  Nubia  were  in 
a  state  of  anarchy.  The  employment  of  native  officers  and  soldiers 
ultimately  led  to  a  revolution,  for  he  realized  as  little  as  some 
administrators  do  now  that  one  cannot  give  away  power  and  at  the 
same  time  retain  it. 

Allowing,  then,  for  the  exaggerations  of  Polybius,  of  Strabo,  and 
of  the  Jews,  whom  he  had  offended,  the  king  may  be  described 
as  a  man  whose  life  was  soiled  by  culpable  weakness  and  debauchery, 
but  to  some  extent  redeemed  by  a  love  of  art  and  letters,  and 
who,  in  his  political  actions,  showed  considerable  ability  and 
originality.    The  only  known  child  of  Ptolemy  IV  and  his  sister  was 

'  Mahaffy,  op.  cit.,  p.  138. 


346         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Ptolemy  V  Epiphanes  (born  209) ,  and  as  both  king  and  queen  died 
in  204,  their  other  progeny,  if  any,  cannot  have  been  numerous. 

Ptolemy  V  was  only  five  years  old  when  he  came  to  the  throne. 
He  was  betrothed  to  Cleopatra,  a  Syrian  princess,  when  eleven  years 
of  age  (198  B.C.)  and  married  her  five  years  afterwards. 

On  the  coins  of  the  period  we  see  a  stout,  distinctly  good-looking 
young  man  (Fig.  27,  6).  He  enjoyed  a  great  reputation  as  an 
athlete  and  was  fond  of  field  sports,  and  like  his  forefathers,  he  was 
cruel,  treacherous,  and  tyrannical  whenever  it  suited  his  purpose 
to  be  so.  His  foreign  policy  certainly  was  not  a  success,  but,  as 
Mahaffy  explains,  he  is  hardly  to  be  blamed  for  the  sore  diminution 
of  the  Egyptian  empire  during  his  reign ;  for  the  rise  of  the  Romans, 
the  astuteness  of  Antiochus,  the  invasion  of  his  island  empire  by 
Philip,  and  his  predecessor's  mistaken  policy  of  arming  the  natives 
were  all  factors  which  would  have  beaten  the  strongest  man.  He 
died  at  the  age  of  twenty-nine,  and  it  is  not  improbable  that  he  was 
murdered. 

The  marriage  of  Ptolemy  V  Epiphanes  with  the  Syrian  princess 
was  blessed  with  at  least  four  children.  One  son,  Ptolemy  VI 
Eupator,  died  young.  Another  son,  Ptolemy  VII  Philometor 
(Fig.  27,  9),  the  descendant  of  consanguineous  grandparents,  was 
seven  years  old  when  he  ascended  the  throne  (181  B.C.)  and  was 
killed  at  the  age  of  forty-three  (145  B.C.).  When  still  a  boy  of 
fifteen  he,  with  his  sister-wife  Cleopatra  II,  successfully  organized 
the  resistance  to  King  Antiochus,  quelled  rebellions  in  Upper  and 
Lower  Egypt,  reconquered  and  pacified  Nubia.  In  Upper  Egypt 
he  did  considerable  building  work.  His  quarrels  with  his  brother, 
the  clever  and  unscrupulous  Ptolemy  IX  Euergetes  II,  would  fill  a 
volume.  His  treatment  of  his  brother  was  magnanimous,  for 
having  taken  him  prisoner,  he  spared  his  life,  and  forgetting  the  past 
suggested  they  should  form  a  new  alliance  by  a  marriage  between  his 
own  daughter  and  Euergetes,  to  whom  he  left  Cyrene.  The  fear  of 
the  Romans  may  possibly  have  made  these  arrangements  advisable, 
but  it  is  only  fair  to  assume  that  his  natural  kindness  and  the  ties  of 
blood  urged  him  to  follow  this  course.  King  Philometor  was  the 
Ptolemy,  "virtuous,  pious,  and  kindest  of  men, "  to  whom  the  com- 
panions in  arms  in  Cyprus  dedicated  a  crown  of  gold  in  the  temple 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  347 

of  Delos.  They  thank  him  for  his  benefactions  to  them  and  their 
homes,  but  they  especially  admire  the  kindness  and  magnanimity 
with  which  he  made  friendship  and  peace. 

Cleopatra  Thea,  one  of  the  children  born  of  the  incestuous 
marriage  between  Philomator  and  his  sister,  was  married  to  Alexan- 
der Bela,  king  of  Syria,  and  when  her  father  and  husband  quarrelled, 

TABLE  XIII 
Ptolemy  IV  (Philopator)  =  His  sister  Arsinoe 


Ptolemy  V  (Epiphanes)  =  Cleopatra  (Syrian  princess) 

I                                I               '              I  ;  I 

Ptolemy  VI  (Eupator)  Ptolemy  VII  =  Cleopatra  II  =  Ptolemy  IX  (Euergetes  II) 
(died  young)  (Philometor)        rrrr^^^rr 


she  left  the  latter  and  married  her  husband's  rival,  Demetrius  II. 
The  fortunes  of  war  having  compelled  her  second  husband  to  fly  the 
country  and  to  marry  the  daughter  of  his  captor,  Cleopatra  Thea 
at  once  retaliated  by  marrying  Demetrius'  brother,  Antiochus  VII 
Sidetes.  The  queen  had  children  by  all  these  husbands.  She  was 
not,  as  has  been  suggested,  a  weak  simpleton,  but  a  wicked,  energetic 
woman,  who  shed  blood  whenever  the  success  of  her  plans  required 

TABLE  XIV 
Cleopatra  Thea  =  (1)  Alexander  Bela  =  (2)  DemetriuS'II  =  (3)  Antiochus  Sidetes 


Antiochus  VI  (Epiphanes)         Seleucus      Antiochus  VIII         Antiochus  IX 
(Grypus)  (Cyzicenus) 

it.  She  betrayed  her  husband,  Demetrius  II,  who  was' assassinated 
with  her  knowledge,  murdered  her  son  Seleucus,  and  another  son, 
Antiochus  VIII,  escaped  the  same  fate  only  by  compelling  his 
mother  to  drink  the  poison  she  had  prepared  for  him.  There  was 
no  lack  of  energy,  though  for  evil,  in  this  queen,  the  offspring  of  an 
incestuous  union. 

After  her  brother-husband's  death,  Cleopatra  II  married  her 
other  brother,  Ptolemy  IX  Euergetes  II  (Fig.  27,  10),  by  whom  she 


348         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

is  supposed  to  have  had  one  son,  Memphites,  who  was  assassinated 
by  his  own  father.  The  story,  however,  is  so  obscure  and  improb- 
able that  its  truth  may  well  be  doubted.  Ptolemy  Euergetes  II, 
nicknamed  Physkon  (Sausage),  also  married  his  wife's  daughter, 
Cleopatra  III  (Fig.  27,  11),  at  once  his  niece  and  step-daughter, 
after,  it  is  said,  outraging  her. 

It  is  difficult  to  estimate  justly  the  character  of  this  king,  the 
greatest  historians  differing  in  their  opinion  of  him;  but  the  appreci- 
ation given  by  Mahaffy  appears  so  equitable  and  temperate  that  I 
cannot  do  better  than  reproduce  it  here: 

Our  Greek  authorities  tell  us  of  nothing  but  the  crimes  and  follies  of 
Physkon,  tempered  by  Greek  distractions  of  writing  memoirs,  and  of  dis- 
cussions with  the  learned  Greeks  of  the  Museum.  All  the  world,  not  to  say 
his  own  nation,  are  described  as  filled  with  horror  at  his  enormities.  If  we 
turn  to  inscriptions  and  to  papyri  we  find  the  king  and  his  queens  commemo- 
rated in  friendly  dedications  to  and  by  his  officers  in  Delos,  in  Cyprus  and  in 
Egypt.  He  extends  the  commercial  bounds  of  Egypt  to  the  south  and  east; 
he  keeps  Cyrene  perfectly  still  and  undisturbed,  probably  under  the  vice- 
royalty  of  his  son  Apion.  He  so  far  manages  to  control  two  ambitious 
queens,  probably  at  deadly  enmity,  that  at  the  very  close  of  his  life  they  both 
appear  associated  with  him  in  the  royalty  as  if  nothing  had  happened  to 
disturb  the  peace  of  the  palace.  Throughout  the  country  the  legal  and  fiscal 
documents  still  extant  show  the  prevalence  of  law  and  order. 

Modern  criticism,  suspicious  of  the  exaggerations  familiar  to  ancient  rheto- 
ricians, may  lighten  the  burden  of  crimes  and  maledictions  with  which  he  is 
charged,  but  it  is  not  possible  to  wipe  out  all  the  lines  of  this  repugnant  cari- 
cature. He  was,  in  any  case,  an  energetic  figure,  a  despot  without  scruples, 
but  not  without  intellect,  who  seems  to  have  summed  up  in  himself  and  carried 
away  all  the  virility  of  his  race.1 

His  wife  and  niece,  Cleopatra  III,  a  masterful  woman,  had  an 
almost  pathological  hatred  for  her  first  son.  Again  and  again  did 
she  endeavour  to  remove  him  from  the  throne  and  to  place  the  crown 
of  Egypt  on  the  head  of  her  second  son,  Ptolemy  XI  Alexander. 
"Never,  that  we  know  of,"  wrote  Pausanias,  "was  there  a  king  so 
hated  by  his  mother. "  For  many  years  the  history  of  Egypt  is  that 
of  the  quarrel  and  intrigues  of  this  strong-minded  woman  and  her 
two  sons.  The  first  son,  Ptolemy  X,  nicknamed  Lathyrus,  married 
his  sister,  Cleopatra  IV,  during  his  father's  reign,  and  a  son  had 

1  Mahaffy,  op.  cit.,  p.  202a. 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  349 

been  born  when  his  mother,  Cleopatra  III,  compelled  the  young 
king  to  repudiate  his  wife  and  to  marry  his  other  sister,  Cleopatra 
Selene,  who  had  two  sons  by  him.  When  Lathyrus  had  to  fly  from 
Egypt,  Selene  retired  to  Syria,  where  she  married  three  husbands  in 
succession  and  was  finally  put  to  death  by  Tigranes,  king  of  Armenia, 
after  having  had  four,  probably  five,  and  perhaps  more  sons,  by  her 
four  husbands ;  of  these  the  first  was  her  brother,  the  second  and  the 
third  her  cousins  (the  second  being  himself  a  descendant  of  an 
incestuous  marriage),  and  the  fourth  her  step-son  and  second 
cousin.  She  is  the  only  Cleopatra  who  is  not  guilty  of  one  or  more 
murders  during  her  adventurous  career. 


Ptolemy  VII  =  his  sister,  Cleopatra  II  =  also  her  brother,  Ptolemy  IX 
Philometor     I  EuergetesJI 

Cleopatra  III  =  her  uncle,  Ptolemy  IX 

I  "  1  I  1 

Ptolemy  X,  Soter  II  =  (1)  Cleopatra  IV  and  (2)  Cleopatra    Cleopatra    Ptolemy  XI 

Selene      Tryphaena  (Alexander  I) 

(Lathyrus)  1 

m.  Berenike  III 
One  son     Berenike  III        Two  sons 


Meanwhile,  Cleopatra  IV,  the  first  wife  of  Ptolemy  X  Lathyros, 
had  gone  to  Cyprus,  enlisted  a  number  of  mercenaries,  proceeded  to 
Syria,  married  Antiochus  IX,  and  attacked  Antiochus  VIII,  the 
husband  of  her  sister  Tryphaena.  The  sister,  getting  the  upper 
hand,  had  her  put  to  death. 

Cleopatra  Ill's  last  daughter,  Tryphaena,  married  Antiochus 
VIII  Grypos,  and  after  perpetrating  the  crimes  mentioned  above 
was  herself  murdered  by  Antiochus  XI. 

The  history  of  the  four  Cleopatras,  the  daughters  and  grand- 
daughters of  incestuous  marriages,  is  a  long  relation  of  intrigues  and 
appalling  crimes.  All  had  sons  and  grandsons  of  whom  some  are 
known  by  name.  Very  probably  many  more  have  been  entirely 
forgotten. 

Ptolemy  X  Lathyrus  died  in  80  B.C.  at  the  age  of  sixty-two.  His 
brother  and  rival  Ptolemy  Alexander  I  had  been  killed  in  88  B.C. 


350         STUDIES  IN  THE  PALAE0PATH0L0GY  OF  EGYPT 

He  was  probably  about  forty  years  old  at  the  time,  and  was  said  to 
have  repaid  his  mother's  kindness  to  him  by  murdering  her.  He 
resembled  her  physically;  for  she  was  nicknamed  kokkt]  and  he 
KoKK-qs,  "the  red  one."  It  is  difficult  to  form  an  estimate  of  these 
two  brothers'  characters,  so  completely  overshadowed  are  they  by 
the  striking  personality  of  the  queen-mother.  She  it  is  who  occupies 
the  stage;  a  clever,  daring,  ruthless,  intriguing  woman,  who  for 
thirty  years  was  the  all-powerful  ruler  of  Egypt,  and  certainly  her 
incestuous  origin  did  not  prevent  her  from  displaying  remarkable 
energy. 

Lathyrus,  by  his  marriage  with  his  sister  Cleopatra  IV,  had  a 
daughter,  Berenike  III,  who  married  her  uncle  Ptolemy  XI  Alexan- 
der I,  and  one  son,  who  was  murdered.  Posidonius  of  Rhodes,  a 
contemporary,  draws  a  portrait  of  this  sovereign  which  is  not 
without  humour: 

The  dynast  of  Egypt,  hated  by  the  people,  but  flattered  by  those  round 
him,  lived  in  great  luxury,  and  could  not  walk  otherwise  than  supported  by 
two  acolytes;  but  in  banquets,  when  he  became  excited,  he  jumped  from  the 
couch,  and  executed,  barefoot,  dances  with  greater  agility  than  professional 
dancers. 

When  Ptolemy  XI  Alexander  I  died,  his  son,  Ptolemy  XII  Alex- 
ander II,  by  a  second  wife,  following  the  advice  of  Sylla,  married 
his  step-mother,  and  was  murdered  shortly  afterwards,  after  putting 
his  wife  to  death. 

The  direct  line  of  the  Ptolemies  now  comes  to  an  end,  not  because 
the  women  had  become  barren,  or  the  men  unable  to  beget  children, 
but  because  all  the  male  descendants  born  in  legitimate  wedlock  had 
been  killed  or  exiled. 

II.      INDIRECT   LINES 

Ptolemy  X  Lathyrus  (Fig.  27,  12)  had  left  two  illegitimate  sons, 
and  one  of  them,  nicknamed  Auletes,  the  flute-player,  now  laid 
claim  to  and  ascended  the  throne,  the  other  son  being  made  king  of 
Cyprus.  The  latter  retained  his  throne  until  the  Romans  occupied 
the  island,  when  rather  than  submit  to  this  indignity  he  poisoned 
himself. 

Auletes  married  Cleopatra  V  Tryphaena  II,  who  was  called  his 
sister  in  official  records,  though  there  is  no  proof  that  she  stood 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  351 

in  such  relationship  to  him.  His  daughter,  Berenike  IV,  was 
probably  by  this  wife,  and  by  a  second  wife  the  king  had  another 
family,  the  most  prominent  member  of  which  was  Cleopatra  VII, 
the  great  Cleopatra. 

Auletes  is  stated  to  have  been  an  idle,  drunken,  and  wicked  man, 
the  whole  of  these  accusations  resting  on  about  half  a  dozen  anec- 
dotes, which  have  as  little  value  as  have  nowadays  the  countless 
stories  about  royalty.  A  curious  passage  of  Strabo1  shows  that  a 
good  deal  of  the  indignation  of  ancient  Greek  authors  was  due  to  the 
king's  passion  for  what  would  be  now  considered  an  artistic  occupa- 
tion.    Strabo  says: 

Besides  other  deeds  of  shamelessness,  he  acted  the  piper;  indeed,  he 
gloried  so  much  in  the  practice  that  he  scrupled  not  to  appoint  trials  of  skill 
in  his  palace:  on  which  occasions  he  presented  himself  as  a  competitor  among 
other  rivals. 

What  would  Strabo  have  said  of  Frederick  the  Great,  or  of  Ludwig 
of  Bavaria,  or  of  the  Royal  Duke  who  played  the  violin  obbligato  for 
a  distinguished  singer  at  a  public  concert  ? 

TABLE  XVI 

Cleopatra  V  =  Ptolemy  XIII  Auletes  =  N.  N. 

Cleopatra  VT  =  Archelaus 
(murdered) 


I  I  I  I 

Ptolemy  XV        Ptolemy  XIV        Arsinoe        Cleopatra  VII 

(murdered)      

(died  young,  (drowned)  m.  her  brothers 

probably  poisoned) 

The  king  had  no  easy  task.  He,  a  bastard,  had  to  defend  his 
throne  against  those  who  had  perhaps  a  more  legitimate  claim  to  the 
throne.  No  doubt  he  fleeced  his  country,  but  let  it  be  remembered 
in  his  favour  that  his  only  chance  of  keeping  the  throne  was  by 
bribing  the  whole  of  the  Roman  senate,  and  by  becoming  the  prey  of 
Roman  money-lenders.  His  financial  struggles,  and  indeed  his 
whole  history,  curiously  resemble  the  history  of  some  very  modern 
ruhrs.     To  keep  himself  on  the  throne  at  all  was  a  truly  marvellous 

1  Strabo  xvii.  I,  II. 


352         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

feat,  and  however  disgraceful  his  private  life  may  have  been,  his 
cleverness  and  genius  for  intrigue  were  remarkable. 

His  son,  generally  described  as  a  puppet  in  the  hands  of  his 
attendants,  clearly  was  not  responsible  for  the  murder  of  Pompey. 
He  fought  a  gallant  fight  against  Julius  Caesar,  and  though  but  a  boy 
without  experience,  behaved  with  decision  and  bravery  and  perished 
in  battle. 

A  just  estimate  of  the  great  Cleopatra  (Fig.  26)  is  an  almost  hope- 
less task,  for  the  accounts  of  her  life,  as  Weigall  has  pointed  out, 
are  written  by  her  enemies.  Her  amours  with  Caesar  and  with 
Antony  must  not  be  judged  according  to  our  standard,  and  though 
it  would  probably  be  going  too  far  to  maintain  that  her  intrigues 
with  these  two  men  were  for  political  reasons  only,  there  can  be  no 
doubt  that,  had  she  resisted  either  of  them,  Egypt  would  have  been 
lost  to  her  and  to  her  dynasty.  It  is  sheer  nonsense  to  look  upon 
Caesar  or  Antony  as  the  unfortunate  victim  of  a  designing  woman. 
By  the  time  Caesar  met  Cleopatra  he  was  an  elderfy  man,  who  had 
ruined  the  wives  and  daughters  of  an  astonishing  number  of  his 
friends,  and  whose  reputation  for  such  seductions  was  of  a  character 
almost  past  belief.  Antony  also  was  not  a  boy  but  a  man  of  the 
world,  une  homme  a  femmes,  who  had  seduced  many  women. 
Cleopatra  at  that  time  was  a  girl  twenty-one  years  old,  against 
whose  character  not  one  shred  of  trustworthy  evidence  has  been 
advanced..  The  prodigality,  the  luxury  and  licence  of  her  court 
were  those  of  every  eastern  court  of  her  time,  and  no  great  blame  can 
be  attached  to  her  endeavouring  to  please  Caesar  and  Antony  by 
sumptuous  entertainments.  The  responsibility  for  such  waste  of 
money  should  be  put  with  much  greater  justice  at  the  door  of  those 
who  allowed  her  to  squander  fortunes  on  their  amusement. 

Certainly,  the  audacity,  cleverness,  and  resources  of  this  Egyp- 
tian queen,  the  last  offspring  of  many  incestuous  marriages,  compel 
our  admiration,  and  had  not  Caesar's  murder  put  an  end  to  her 
ambitions,  she  might  have  become  the  empress  of  the  world !  She 
was  musical,  artistic,  and  encouraged  science;  her  good  spirits 
were  proverbial,  and  induced  her  to  play  harmless  and  rather 
pointless  practical  jokes.  She  was  considered  a  very  fine  linguist, 
perhaps  not  a  great  achievement  in  a  town  where,  to  this  day,  every 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES 


353 


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354         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

inhabitant  speaks  three  languages  as  a  rule,  where  many  can  con- 
verse in  five,  six,  or  seven  tongues,  and  official  correspondence  is 
carried  on  in  three  languages. 

Of  her  physical  appearance  we  know  but  little.  Her  portraits,  if 
authentic,  do  not  give  one  the  idea  of  a  very  beautiful  woman,  and 
her  charm  was  probably  one  of  manner.     Dion  Cassius  says: 

She  was  splendid  to  hear  and  to  see,  and  was  capable  of  conquering  the 
hearts  which  had  resisted  most  obstinately  the  influence  of  love  and  those 
which  had  been  frozen  by  age. 

Another  author1  expresses  himself  as  follows: 

Now  her  beauty,  as  they  say,  was  not  in  itself  altogether  incomparable 
nor  such  as  to  strike  those  who  saw  her:  but  familiarity  with  her  had  an 
irresistible  charm,  and  her  form,  combined  with  her  persuasive  speech  and 
the  peculiar  character  which  in  a  manner  was  diffused  about  her  behaviour, 
produced  a  certain  piquancy.  There  was  a  sweetness  in  the  sound  of  her 
voice  when  she  spoke. 

The  two  charges  of  cruelty  always  brought  against  her  are  that 
she  murdered  her  sister,  Arsinoe  IV,  and  her  brother,  Ptolemy  XV. 
The  blame  for  the  murder  of  her  sister  is  minimized  by  the  fact  that 
Arsinoe,  who  had  declared  war  against  her,  would  have  shown  no 
mercy  had  she  won  the  day;  and  with  regard  to  Ptolemy  XV,  there 
is  no  proof  that  he  was  murdered,  and  if  he  was,  the  deed  was  done 
at  Rome  when  Cleopatra  was  entirely  under  Caesar's  influence,  and 
in  his  power.  Her  end,  when  rather  than  grace  her  conqueror's 
triumph  she  committed  suicide,  was  that  of  a  plucky  woman 
(Fig.  27,  13). 

Cleopatra  had  one  son  by  Julius  Caesar  and  three  children  by 
Antony.-  The  son  was  murdered  and  two  children  are  known  to 
have  married  and  to  have  had  children. 

in.      SUMMARY 

The  Ptolemies  born  from  consanguineous  unions  were  neither 
better  nor  worse  than  the  first  four  kings  of  the  same  family  issued 
from  non-consanguineous  marriages,  and  had  the  same  general 
characteristics.  Their  conduct  of  foreign  affairs  and  of  internal 
administration  was  in  every  way  remarkable  and  energetic.     They 

1  Plutarch  Life  of  Anlonius  27. 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  355 

were  not  unpopular  in  their  capital,  and  the  Alexandrians  rallied 
round  their  rulers  when  the  Romans  entered  Egypt,  and  resisted 
the  foreigner. 

Though  much  has  been  written  about  the  awful  sexual  immoral- 
ity of  the  Ptolemies,  they  must  not  be  judged  by  comparison  with 
the  morals  of  this  century,  but  an  opinion  must  be  based  on  the 
study  of  the  literature  and  customs  of  the  time.  The  chief  charac- 
teristic of  the  Alexandrian  literature  is  its  eroticism,  and  the  stand- 
ard of  morality  was  as  low  as  it  possibly  could  be.  The  spirit  of 
disparagement  which  existed  always  led  to  a  systematic  slandering 
of  the  reigning  king;  and,  later  on,  the  Romans  industriously 
blackened  the  character  of  their  future  opponents.  Thus  it  is  not 
unlikely  that  the  Ptolemies  were  better  than  they  have  been 
painted.  Their  standard  of  morality  was  certainly  not  lower  than 
that  of  their  fellow-townsmen. 

The  children  from  these  incestuous  marriages  displayed  no  lack 
of  mental  energy.  Both  men  and  women  were  equally  strong, 
capable,  intelligent,  and  wicked.  Certain  pathological  character- 
istics doubtless  ran  through  the  family.  Gout  and  obesity  weighed 
heavily  on  the  Ptolemies,  but  the  tendency  to  obesity  existed  before 
consanguineous  unions  had  taken  place. 

The  male  and  female  effigies  on  coins  are  those  of  very  stout, 
well-nourished  persons.  The  theory  that  the  offspring  of  incestu- 
ous marriages  is  short-lived  receives  no  confirmation  from  the 
history  of  the  Ptolemies. 

The  length  of  life  of  the  Ptolemaic  kings  was  as  follows: 

Age  at  Death 

Ptolemy  I  Soter 84 

Ptolemy  II  Philadelphus 62 

Ptolemy  III  Energetes 63 

Ptolemy  IV  Philopator 39  (murdered  ?) 

Ptolemy  V  Epiphanes 28  (killed  ?) 

Ptolemy  VI  Eupator —  (?) 

Ptolemy  VII  Philometor 42  (killed?) 

Ptolemy  IX  Euergetes  II 60 

Ptolemy  X  Soter  II  (Lathyros) 61 

Ptolemy  XI  Alexander  1 62 

Ptolemy  XII  Alexander  II 20  (killed?) 

Ptolemy XIII  Auletes 59 

Ptolemy  XIV  and  Ptolemy  XV —  (both  killed  young) 


356         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

Omitting  those  who  died  violent  deaths,  the  average  length  of 
life  of  the  Ptolemies  was  sixty-four  years.  Several  women  of  the 
family  reached  an  advanced  age,  amounting  in  three  cases  to  over 
sixty  years.  Owing  to  the  lack  of  statistics  in  ancient  Alexandria, 
it  is  impossible  to  compare  the  length  of  life  of  Ptolemaic  kings  with 
that  of  other  Alexandrian  families.  But  when  we  consider  the 
nature  of  these  lives,  diversified  by  intrigues,  murders,  wars,  and 
debauchery,  we  may  admit  that  the  Ptolemies  possessed  remark- 
ably strong  constitutions. 

Sterility  was  not  a  result  of  these  consanguineous  marriages.  No 
case  of  idiocy,  deaf-mutism,  etc.,  in  Ptolemaic  families  has  been 
reported.  With  regard  to  the  theory  that  hereditary  pathological 
tendencies  are  "reinforced"  by  consanguineous  marriages,  cousins 
or  near  relatives  who  marry  are  not  usually  affected  with,  nor  pre- 
disposed to,  deaf-mutism,  idiocy,  epilepsy,  nor  to  the  other  infirmi- 
ties which  are  said  to  threaten  the  children  of  consanguineous 
parents.  There  can  be  no  question  of  any  reinforcement  of  a 
hereditary  tendency  which  does  not  exist  on  either  side.  The  his- 
tory of  the  Ptolemies  does  not  show  that  their  predisposition  to 
obesity  or  to  gout  was  increased  by  their  consanguineous  marriages. 
Had  the  families  of  these  monarchs  suffered  from  some  hereditary 
disease,  the  local  satirists  would  have  made  capital  of  it,  with  due 
exaggeration,  and  the  fact  that  they  were  silent  is  of  the  utmost 
importance. 

DESCRIPTION  OF  PLATES  LXIII-LXXI 
(The  following  described  figures  are  referred  to  in  the  text  by  number  only.) 

plate  Lxm 
Fig.  i. — Nefertari. 

Fig.  2. — Queen  Nefertari,  wife  of  Ahmose  I.  From  a  wooden  statue  at 
Turin  (Alinari). 

Fig.  3. — Amenhotep  I.     (British  Museum.)     (W.  A.  Mansell.) 

PLATE   LXTV 

Fig.  4. — Mummified  head  of  Thutmose  I.  From  G.  Elliot  Smith's 
Catalogue  general  des  anliqiiites  egyptiennes  dn  Musee  du  Caire,  Cairo,  191 2. 

Fig.  5. — Queen  Aahmes.  From  E.  Naville's  The  Temple  of  Deir-el-Bahri, 
London,  1898. 

Fig.  6. — Mummified  head  of  Thutmose  II.     (Bonfils.)     (Cairo  Museum.) 


PLATE  LXIII 


PLATE  LXIV 


Fig.  4 


PLATE  LXV 


Fig.  io 


Fig.  7 


Fig.  9 


PLATE  LXVI 


Frc  14 


PLATE  LXVII 


Fig.  17 


PLATE  LXVIII 


Fig.  19 


Fie.  23 


PLATE  LXTX 


Fie.  24 


Fig.  25 


PLATE  LXX 


PLATE   LXXI 


i& 


EFFECTS  OF  CONSANGUINEOUS  MARRIAGES  357 

PLATE   LXV 

Fig.  7. — Thutmose  III.     (British  Museum.) 

Fig.  8. — Amenhotep  II.  (Karnak.)  From  Legrain's  Catalogue  general 
des  antiquites  egyptiennes  du  Musee  du  Caire,  Cairo,  1906. 

Fig.  9. — Mummified  head  of  Thutmose  IV.  From  G.  Elliot  Smith's 
Catalogue  general  des  antiquites  egyptiennes  du  Musee  du  Caire,  Cairo,  191 2. 

Fig.  10. — Amenhotep  III.  From  Legrain's  Catalogue  general  des  antiquites 
egyptiennes  du  Musee  du  Caire,  Cairo,  1906. 

PLATE   LXVI 

Fig.  11. — Queen  Tiy.     (Berlin.) 

Fig.  12. — Amenhotep  IV.     (Berlin.) 

Fig.  13. — Amenhotep  IV  or  Akhnaton.     From  a  statue  in  the  Louvre. 

Fig.  14. — Death  mask  of  Akhnaton. 

PLATE  lxvii 

Fig.  15. — Seti  I,  offering.     (Abydos.) 

Fig.  16. — Seti  I.     (Bonfils.)     (Cairo  Museum.) 

Fig.  17. — Ramses  II. 

Fig.  18. — Mummified  head  of  Ramses  II.     (Bonfils.)     (Cairo  Museum.) 

PLATE   LXVIII 

Fig.  19. — Merneptah.     Gray  granite  figure  from  his  temple  at  Thebes. 

Fig.  20. — Merytamen,  daughter  of  Ramses  II. 

Fig.  21. — Seti  II.     From  his  statue. 

Fig.  22. — Takhat.     From  tomb  of  Amenmeses. 

Fig.  23. — Amenmeses.     From  his  tomb. 

PLATE  LXLX 

Fig.  24. — Ptolemy  II  Philadelphus.     (Vatican,  Rome.) 
Fig.  25. — Arsinoe  II,  ux.  Philadelphus.     (Vatican,  Rome.) 

PLATE    LXX 

Fig.  26 — Cleopatra  VII.     (Bonfils.)     (Dendera.) 

plate  lxxi 

Fig.  27. — Images  of  royal  Egyptians  as  portrayed  on  coins  of  the  period. 
(1)  Ptolemy  I  (Soter);  (2)  Ptolemy  III  (Euergetes);  (3)  Berenike  II;  (4) 
Ptolemy  IV  (Philopator  I);  (5)  Arsinoe  III  (Philopator  XV);  (6)  Ptolemy  V 
(Epiphanes);  (7)  Ptolemy  II  (Philadelphus);  (8)  Arsinoe  II;  (9)  Ptolemy  VII 
(Philometor);  (10)  Ptolemy  IX  (Euergetes  II);  (11)  Cleopatra  III;  (12) 
y  X  (Lathyrus);  (13)  Cleopatra  VII. 


APPENDIX 

CHRONOLOGICAL  LIST  OF  EGYPTIAN  KINGS  AND 
DYNASTIES1 

(N.B. — All  dates  with  asterisks  are  astronomically  fixed.) 

B.C. 

Predynastic  kingdoms  already  flourishing 4500 

Introduction  of  calendar  and  earliest  fixed  date  in  history *424i 

Kingdoms  of  Upper  and  Lower  Egypt  probably  flourishing  by.  .  .  4000 

Accession  of  Menes  and  beginning  of  dynasties 34°° 

First  and  Second  Dynasties 3400-2980 

Eighteen  kings,  420  years,  ruling  at  Thinis.  Tombs  in  Abydos 
and  vicinity.  Wars  with  Libyans,  with  Beduin  of  East,  with 
Delta.  Mining  in  Sinai.  Stone  masonry  and  arch  intro- 
duced. (Recent  investigations  would  indicate  that  we  may 
possibly  have  to  push  back  the  beginning  of  the  First  Dynasty 
a  number  of  centuries,  possibly  even  before  4000  B.C.) 

OLD  KINGDOM— 2980-2475  B.C. 

Third  Dynasty 2980-2900 

Zoser  to  Snefru,  80  years,  ruling  at  Memphis.  Zoser  builds 
terraced  pyramid  of  Sakkara,  the  oldest  existing  large  stone 
building;  continues  mining  in  Sinai;  wise  man  Imhotep. 
Snefru  builds  first  real  pyramids :  one  at  Medum,  another  at 
Dahshur;  sends  fleet  to  Lebanon  (earliest  known  sea  voyage 
and  expedition  into  Syria  in  history);  continues  mining  in 
Sinai. 

Fourth  Dynasty  (Memphis),  150  years 2900-2750 

Pyramids  at  Gizeh  and  Abu  Roash. 

1.  Khufu,  23  years 2900-2877 

Great  Pyramid  of  Gizeh.    Highest  prosperity  of  Old  Kingdom. 

2.  Dedefre,  8  years 2877-2869 

3.  Khafre,  *  years. 

Second  Pyramid  of  Gizeh    I  2869-2774 

4.  Menkure,  x  years. 

Third  Pyramid  of  Gizeh 

5 ,  x  years. 

6 ,18  years 2774-2756 

1  From  J.  H.  Breasted's  A  History  of  the  Ancient  Egyptians  (1920). 

358 


APPENDIX  3  59 

B.C. 

7.  Shepseskaf,  4  years 2756-2752 

8 ,2  years 2752-2750 

Triumph  of  Heliopolis  and  solar  theology  (2750). 

Fifth  Dynasty,  Memphis,  125  years 2750-2625 

Offices  become  hereditary.     Pyramids  at  Abu  Sir  and  Sakkara. 

1.  Userkaf,  7  years about     2750-2743 

First  Pharaoh  recorded  at  First  Cataract. 

2.  Sahure,  12  years about     2743-2731 

Mining  in  Sinai.  First  expedition  to  Punt  (Ophir).  Naval 
expedition  to  Phoenicia.     Earliest  colonnades. 

3.  Neferirkere,  x  years      1 

4.  Shepseskere,  7  years     I 2731-2721 

5.  Khaneferre,  x  years 

6.  Nuserve,  30  years 2721-2691 

7.  Menkuhor,  8  years 2691-2683 

8.  Dedkere-Isesi,  28  years 2683-2655 

First  Pharaoh  recorded  at  Hammamat.  Second  expedition 
to  Punt. 

9.  Unis,  30  (+x)  years 2655-2625 

Earliest  Pyramid  Texts. 

Sixth  Dynasty,  Memphis,  150  years 2625-2475 

Pyramids  at  Sakkara.     Appearance  of  landed  nobles  detached 
from  court. 

1.  Teti  II,  x  years     1  ' 2625-2590 

2.  Userker,  x  years    J 

3.  Pepi  I,  20  years 2590-2570 

Residence  now  first  called  Memphis.  Five  primitive  expedi- 
tions into  Sinai.  Earliest  expedition  into  Palestine  in 
history.  Control  of  Northern  Nubia.  Nubian  mer- 
cenaries common  in  Egyptian  army. 

4.  Mernere  I,  4  years 2570-2566 

Canal  in  First  Cataract.  Pharaoh  receives  homage  of 
Nubian  chiefs  at  First  Cataract.  Harkhuf's  trading 
expeditions  to  far  south,  Yam,  and  the  Sudan — earliest 
expeditions  into  inner  Africa. 

5.  Pepi  II,  90  (+x)  years  (longest  reign  in  history) 2566-2476 

Harkuf's  trading  expeditions  in  Sudan  continue.  Mekhu 
and  Sebni's  expeditions  in  Sudan.  Campaigns  in  Northern 
Nubia.  Loose  sovereignty  in  Northern  Nubia.  Expedi- 
tions to  Punt  (Ophir)  common.  Commerce  with  Lebanon 
and  Aegean.     Decline  of  Memphis. 

6.  Mernere  II,  1  year 2476-2475 

Fail  of  Old  Kingdom. 


360         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

B.C. 

Seventh  and  Eighth  Dynasties.    Known  total  30  years 2475-2445 

Collapse  of  Memphis. 

Ninth  and  Tenth  Dynasties,  Heracleopolis,  estimated  285  years.    2445-2160 
Eighteen  feeble  kings  residing  at  Heracleopolis.     Rise  of  Thebes 
under  Intefs.     Struggle  with  Thebes;   tombs  at  Siut;  fall  of 
Heracleopolis;  triumph  of  Thebes. 

MIDDLE  KINGDOM,  2160-1788  B.C. 

Eleventh  Dynasty,  Thebes,  160  years 2i6o-*20oo 

Pyramids  at  Thebes. 

1.  Horus  Wahenekh-Intef,  50  (+x)  years. 

Tomb  at  Thebes. 

2.  Horus  Nakhtneb-Tepnefer-Intef,  x  years. 

3.  Horus  Senekhibtowe-Mentuhotep,  x  years. 

4.  Nibhapetre-Mentuhotep,  x  years. 

Tomb  at  Thebes. 

5.  Nibtowere-Mentuhotep,  2  (+x)  years. 

Expedition  to  Hammamat. 

6.  Nibhepetre-Mentuhotep,  46  (+x)  years. 

Expedition  against  Nubia.     Earliest  temple  at  Thebes. 

7.  Senekhkere-Mentuhotep,  8  (+x)  years. 

Expedition  to  Hammamat  and  Punt. 

Twelfth  Dynasty,  Thebans,  213  years *2ooo-*i788 

Residence  at  Lisht  and  in  Fayum. 

1.  Amenemhet  I,  30  years *2ooo-*io70 

Feudal  organization  perfected ;  great  prosperity.  Sesostris  I, 
10  years  coregent  (1980-1970).  Expedition  into  Wawat 
(1971).  Canal  connecting  Nile  and  Red  Sea;  frequent 
intercourse  with  Syria;  Egyptians  in  Syria.  Pyramid  at 
Lisht. 

2.  Sesostris  I,  45  years : *i98o-*i935 

Ten  years  coregent  with  Amenemhet  I.  Nubian  conquest 
carried  into  Kush — first  foreign  campaign  led  by  a  Pharaoh 
personally.  Amenemhet  II,  3  years  coregent.  Pyramid 
at  Lisht. 

3.  Amenemhet  II,  35  years *i93&~*19°3 

Three  years  coregent  with  Sesostris  I;  expeditions  to  Sinai, 
Nubian  mines,  Punt.  Three  years  coregent  with  Sesostris 
II.     Pyramid  at  Dahshur. 

4.  Sesostris  II,  19  years *i9o6-*i887 

Three  years  coregent  with  Amenemhet  II.  Traffic  with 
Punt.     Pyramid  at  Illahun. 


APPENDIX  361 

B.C. 

5.  Sesostris  III,  38  years *i887-*i849 

New  canal  through  First  Cataract.  Subjugation  of  Lower 
Nubia  to  Second  Cataract  complete.  Expeditions  thither 
in  years  8,  12,  16,  19.  Southern  frontier  established  at 
Semneh  in  year  8  (1879).  First  campaign  of  Middle 
Kingdom  in  Syria.  Semitic  traders  in  Egypt.  Monu- 
ments of  Egyptian  officials  in  Gezer  (Palestine).  Com- 
merce with  Aegean.  Nomarchs  decline.  Oldest  known 
drama;  strophic  poetry;  tales.  "Messianic"  prophecy, 
earliest  Book  of  the  Dead.  Coregency  with  son.  Pyramid 
at  Dahshur. 

6.  Amenemhet  III,  48  years *i849-*i8oi 

Coregency  with  father.  Great  development  of  resources; 
nomarchs  suppressed;  activity  in  Sinai;  regulation  of 
Nile  and  irrigation;  Lake  Moeris;  Fayum  exploited; 
Labyrinth.     Pyramid  at  Dahshur,  possibly  also  at  Hawara. 

7.  Amenemhet  IV,  9  years *i8oi-*i792 

Decline  of  Middle  Kingdom. 

8.  Sebeknefrure  (queen),  4  years *i792-*i788 

Fall  of  Middle  Kingdom. 

Thirteenth  to  Seventeenth  Dynasties,  208  years *i788-i58o 

Great  confusion,  usurpation,  civil  war.  Hyksos  rule  about  100 
years  (1675-1575?)-  Horse  introduced.  Sekenenre  king  at 
Thebes,  mummy  in  Cairo. 

EMPIRE,  FIRST  PERIOD,  1580-1350  B.C. 

Eighteenth  Dynasty,  Thebes,  230  years 1580-1350 

1.  Ahmose  I,  22  (+x)  years i58o-*i557 

Expulsion  of  Hyksos  by  1580.  Extermination  of  landed 
nobles;  lands  revert  to  crown.  First  standing  army; 
military  state  organized.  Campaign  in  Syria.  Tomb  at 
Thebes;  mummy  at  Cairo. 

2.  Amenhotep  I,  10  (+*)  years. 

Campaign  in  Syria;  against  Libyans.    Tomb  at  Thebes; 
mummy  at  Cairo. 

3.  Thutmose  I,  30  (+*)  years. 

Conquest  of  Kush  to  above  Third  Cataract.     Conquest  of 

Syria,  tablet  of  victory  on  Upper  Euphrates. 
4-5.  Thutmose  III,  including  Thutmose  II  and  Hatshepsut,  54 

years *i5oi-*i447 

Accession  of  Thutmose  III  and  Hatshepsut,  May  3,  1501. 

Feuds   in    royal   family.     Coregents   supplanted   about 

1496  by 


i5S7-*i5°i 


362         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

B.C. 

6.  Thutmose  II,  about  3  years about     1496-1493 

Expedition  against  Nubia.    Accepts  coregency  of  Thutmose 
III.    Mummy  at  Cairo.     Succeeded  by 
4-5.  Thutmose  III  and  Hatshepsut 1493-1480 

Splendid  buildings  and  expedition  to  Punt  by  queen.     She 
dies  1481  (1479).     Tomb  at  Thebes. 
4.  Thutmose  III  alone,  33  years *i479~*i447 

Seventeen  campaigns  in  Asia  (1479-1459).  Asiatic  empire 
consolidated;  frontier  established  on  Upper  Euphrates. 
Egyptian  fleet  developed.  Empire  organized  from 
Euphrates  to  Fourth  Cataract.  First  great  empire  in 
history.  Great  buildings;  vast  wealth.  Son  made  co- 
regent  (1448).  King  dies,  March  17,  1447.  Tomb  at 
Thebes;  mummy  at  Cairo. 

7.  Amenhotep  II,  26  (+*0  years *i448-i42o 

Coregent  with  father.  Campaign  to  Euphrates;  toNapata. 
Empire  maintained.     Mummy  still  in  tomb  at  Thebes. 

8.  Thutmose  IV,  8  (+x)  years 1420-1411 

Campaign  in  Asia ;  in  Nubia.  Asks  and  secures  Mitannian 
princess  in  marriage.  Tomb  at  Thebes;  mummy  at 
Cairo. 

9.  Amenhotep  III,  36  years 141 1-1375 

Greatest  splendor  of  the  empire.  Imperial  Thebes;  vast 
temples;  clear-story  architecture  evolved.  Campaign  in 
Nubia.  Amarna  Letters.  Pharaoh  marries  Mitannian 
princess  Gilukhipa.  Cyprus  vassal  kingdom.  Hittites 
seize  Pharaoh's  north  Syrian  dependencies;  Khabiri 
Semites  begin  migration  into  Syria  and  Palestine. 
Decline  of  empire.  Commerce  with  Babylonia,  Syria, 
Aegean;  Egyptian  monuments  in  Crete  and  Mycenae. 
Tomb  at  Thebes;  mummy  at  Cairo. 

10.  Ikhnaton  (Amenhotep  IV),  17  (+*)  years WS'-iasS 

Introduction  of  earliest  monotheism.  Religious  revolution. 
Thebes  forsaken,  Amarna,  and  Amarna  Letters.  Hittites 
seize  Syria  to  Amor.  Khabiri  Semites  invade  Palestine, 
Hebrews  with  them.  Complete  dissolution  of  Egyptian 
Empire  in  Asia.  Tomb  at  Amarna.  Fall  of  Eighteenth 
Dynasty.     Disorganization. 

11.  Sakere,  x  years. 

12.  Tutenkhamon,  x  years. 

Return  to  Thebes,  Amon  partially  restored,    f 1358-1350 

13.  Eye,  3+x  years. 

End  of  empire,  first  period  (135°)- 


APPENDIX  363 

B.C. 

EMPIRE,  SECOND  PERIOD,  1350  TO  ABOUT  1150  B.C. 

Nineteenth  Dynasty,  City  of  Ramses,  145  years 1350-1205 

1.  Harmhab,  34  (■+*)  years about     1350-1315 

Restoration  of  traditional  religion;  triumph  of  Amon. 
Reorganization  of  government;  Thebes  restored.  Cam- 
paign in  Nubia. 

2.  Ramses  I,  2  years about     1315-1314 

Great  Hall  of  Karnak  begun. 

3.  Seti  I,  21  (+«)  years about     1313-1292 

Palestine  recovered;  first  conflict  with  Hittites.  Campaign 
against  Libyans.  Great  Karnak  Hall  continued.  Nubian 
gold  mines  exploited.  Tomb  at  Thebes;  mummy  at 
Cairo. 

4.  Ramses  II,  67  years about     1292-1225 

Nubian  gold  mines  exploited.  Asiatic  war,  chiefly  with 
Hittites  (1288-1271).  Penetrates  to  North  Syria,  but 
Syria  not  recovered.  Treaty  with  Hittites  (1271).  Great 
Karnak  Hall  completed;  immense  buildings  everywhere. 
Decay  of  art  and  architecture  begin.  Hebrew  oppres- 
sion (?).  Semitic  influences.  Libyan  aggression.  Tomb 
at  Thebes;  mummy  at  Cairo. 

5.  Merneptah,  10  (+2)  years about     1225-1215 

Asiatic  campaign,  "  Israel "  among  defeated,  year  3.  Libyans 
and  northern  allies  defeated  in  Delta,  year  5.  Tomb  at 
Thebes;  mummy  at  Cairo. 

6.  Amenmeses,  x  years about  1215 

Tomb  at  Thebes. 

7.  Siptah,  6  (+«)  years about     1215-1209 

Tomb  at  Thebes. 

8.  Seti  II,  2  (+*)  years about     1 209-1 205 

Exodus  of  Jacob  tribesmen  ( ?) .  Tomb  at  Thebes ;  mummy 
at  Cairo. 

Complete  anarchy  and  Syrian  usurper about     1 205-1 200 

Twentieth  Dynasty,  City  of  Ramses,  no  years 1200-1190 

1.  Setnakht,  1  (-\-x)  years about     1200-1198 

Order  restored.     Tomb  at  Thebes;   mummy  at  Cairo. 

2.  Ramses  III,  31  years about     1198-1167 

First  War:  Defeat  of  Libyans  and  northern  "sea  peoples" 
in  western  Delta,  year  5  (about  1193).  Second  War: 
Defeat  of  northern  "sea  peoples"  in  Syria,  year  8  (about 
1 190).  Third  War:  Second  defeat  of  Libyans  and  "sea 
peoples"  in  western  Delta,  year  11  (about  1187).     Fourth 


364         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

B.C. 

War:  Campaign  in  Amor  (about  1185).  Increase  of  mer- 
cenaries in  army.  Increasing  power  of  Amon.  General 
decline.    Tomb  at  Thebes;  mummy  at  Cairo. 

3.  Ramses  IV,  6  years about     1167-1161 

Tomb  at  Thebes;  mummy  at  Cairo. 

4.  Ramses  V,  4  (+x)  years about     1161-1157 

Tomb  at  Thebes;  mummy  at  Cairo. 

5.  Ramses  VI,  x  years about     1157-1150 

Tomb  at  Thebes;  mummy  at  Cairo. 

DECADENCE  1150-663  B.C. 

6-7.  Ramses  VII  and  VIII,  x  years about     11 50-1 142 

8.  Ramses  IX,  19  years about     1142-1123 

Decay  of  Thebes  begins.  Royal  tombs  robbed.  Tomb  at 
Thebes.     Power  of  high  priest  of  Amon  rapidly  increasing. 

9.  Ramses  X,  1  (+*)  years about     1123-1121 

Tomb  at  Thebes. 

10.  Ramses  XI,  x  years. about     1121-1118 

Tomb  at  Thebes. 

11.  Ramses  XII,  27  {-\-x)  years about     1118-1090 

Pharaoh  reduced  to  a  mere  puppet.  Delta  kingdom 
founded  at  Tanis  by  Nesubenebded  (Smendes).  Sends 
gift  to  Tiglath-pileser  I(?).  High  priest  of  Amon, 
Hrihor,  seizes  throne  at  Thebes.  Pharaoh's  tomb  at 
Thebes. 

TANITE-AMONITE  PERIOD,  1090-945  B.C. 

Twenty-first  Dynasty,  Tanis,  145  years about  1090-945 

Libyans  migrate  steadily  into  Delta  and  fill  army  as  mercenaries. 

1.  Nesubenebded,  Tanite               1                                            ,  „ 

2.  Hrihor,  high  priest  at  Thebes    J  X  yearS ab°Ut  I09°-Io8S 

Egyptian  power  in  Asia  gone. 

3.  Pesibkhenno  I,  17  (+«)  years about  1085-1067 

4.  Paynozem  I,  40  (+»)  years about  1067-1026 

5.  Amenemopet,  49  (+*)  years about  1026-976 

6.  Siamon,  16  (+x)  years about  976-958 

7.  Pesibkhenno  II  (Psusennes),  12  (+#)  years about  958-945 

Libyans  seize  throne.     End  of  Tanite-Amonite  period. 

LIBYAN  PERIOD,  945-712,  B.C. 

Twenty-second  Dynasty,  Bubastis,  200  years about        945-745 

1.  Sheshonk  I,  21  (-\-x)  years about        945-924 

Campaign  in  Palestine;  Jerusalem  captured.  Gezer  pre- 
sented to  Solomon.     Campaign  in  Nubia. 


APPENDIX  365 

B.C. 

2.  Osorkon  I,  36  (+*)  years about  024-895 

3.  Takelot  I,  23  (+x)  years about  895-874 

4.  Osorkon  II,  30  (+x)  years about  874-853 

5.  Sheshonk  II,  00  years. 

Died  about  877  B.C.  during  coregency  with  Osorkon  II. 

6.  Takelot  II,  25  (+x)  years about  860-834 

Probably  contributed  1,000  men  against  Shalmaneser  II  at 
Qarqar  (854).     Seven  years  coregent  with  Osorkon  II. 

7.  Sheshonk  III,  52  years about  834-784 

8.  Pemou,  6  (+*)  years about  784-782 

9.  Sheshonk  IV,  37  (+x)  years about  782-745 

Rise  of  independent  kingdom  in  Nubia. 

Twenty-third  Dynasty,  Bubastis,  27  years about  745-718 

1.  Pedibast,  23  (+x)  years about  745~72i 


NUBIAN  PERIOD,  722-661  B.C. 

2.  Osorkon  III,  14  (+x)  years about         720-718 

Conquest  of  Piankhi.     Tefnakhte  of  Sais. 

3.  Takelot  III,  x  years. 

Twenty-fourth  Dynasty,  Sais,  6  years about        718-712 

Bekneranef  (Bocchoris),  6  (+x)  years.     Slain  by  Shabaka. 

Twenty-fifth  Dynasty,  Napata,  50  years 712-663 

1.  Shabaka,  12  years 712-700 

Gains  all  Egypt.  Incites  revolt  in  Syria  and  Palestine 
against  Sargon.  Aegypto-Nubians  under  Taharka  defeat- 
ed by  Sennacherib  at  Altaqu  (701). 

2.  Shabataka,  12  years 700-688 

3.  Taharka  (Tirhaka),  26  years 688-663 

Defeats  Esarhaddon  (673). 

Assyrian  Supremacy 670-660 

Taharka  defeated  by  Esarhaddon;  Memphis  taken  by  As- 
syrians; Delta  becomes  Assyrian  province  (670).  Delta 
rebels;  Ashurbanipal  retakes  Memphis  (668-666).  Taharka 
retires  to  Napata. 

4.  Tanutamon 663-655 

Nubians  resume  control  of  Delta  (663).  Rise  of  Psamtik  of 
Sais.  Beginning  of  Twenty-sixth  Dynasty  (663).  Nu- 
bians expelled  by  Ashurbanipal;  Thebes  plundered  (661). 
Nubians  return  to  Thebes  and  hold  Upper  Egypt  (661- 
655);  Nubian  rule  at  Thebes  ended  by  654. 


366         STUDIES  IN  THE  PALAEOPATHOLOGY  OF  EGYPT 

B.C. 

Twenty-sixth  Dynasty,  Sais,  138  years 663-525 

1.  Psamtik  I  (Psammeticus),  54  years 663-609 

Several  years  under  Assyrians. 

RESTORATION,  660-525  B.C. 

Alliance  with  Gyges  of  Lydia.  Thebes  gained  (by  654). 
Renaissance  in  art,  religion,  literature,  and  government. 
Archaizing,  retrospective  age.     Great  prosperity. 

2.  Necho,  16  years 609-593 

Invades  Palestine;  defeats  Josiah;  advances  to  Euphrates. 
Defeated  at  Carchemish  by  Nebuchadrezzar  (605). 
Egypt  again  loses  Syria,  Palestine.  Circumnavigation  of 
Africa. 

3.  Psamtik  II,  5  years 593_s88 

Campaign  in  Nubia. 

4.  Apries  (Hophra),  19  years 588-569 

Egyptian  fleet  developed.  Phoenician  coast  taken.  Un- 
successful invasion  of  Palestine  against  Nebuchadrezzar 
(586). 

5.  Amasis  (Ahmose  II),  44  years 569-525 

Nebuchadrezzar  attempts  invasion  of  Egypt  (568).  Death 
of  Apries  (567  or  566).  Alliance  with  Polycrates  of 
Samos.  Greeks  numerous  in  Egypt;  Naucratis  built. 
Great  prosperity.  Egyptian  navy  greatly  increased; 
Cyprus  tributary.  Alliance  with  Babylonia,  Lydia 
(Croesus),  and  Sparta  against  Cyrus  (547). 

6.  Psamtik  III,  a  few  months 525 

Conquest  of  Egypt  by  Cambyses,  the  Persian.  Egypt 
becomes  a  Persian  province. 


INDEX 


INDEX 


Aahmes,  Queen,  356 

Aahotep  I,  Queen,  325 

Abnormalities  of  teeth,  268-321 

Abou  Menas,  236 

Abscesses,  alveolar,  in  ancient  Egyptians, 

123,  146,  301 
Acetabulum,  179 
Achondroplasia,  37,  46 
Adipocere,  62 
Ahmose  I,  325 
Akhnaton,  330,  333,  336 
Alcohol,  29 

Alexander  the  Great,  94,  104,  341 
Alexandria,  63,  94,  141,  276 
Alexandria  Museum,  94,  139 
Alveolar  abscesses,  146,  161 
Amenhotep  I,  327 
Amenhotep  II,  171,  172,  174 
Amenhotep  III,  168,  170,  177,  178 
Amenhotep  IV,  337 
Amon,  the  god,  329 
Amset,  the  human-headed,  58 
Amulets,  195 
Anhapon,  Queen,  174 
Anomalies  of  teeth,  273,  279 
Anthracosis,  15 
Antinoe,  139,  152,  240,  300 
Aorta:   calcified,    23;   of  King  Mernep- 

tah,  20 
Archaeological  Survey  of  Nubia,  1,  93, 

272 
Arsinoe  I,  Queen,  343 
Arteries:  diseases  of,  13,  20;  histology  of, 

13,  74;    lesions  of,  13,  20;   method  of 

isolating,  22 
Arteriosclerosis:     13;     in    the    aorta   of 

King  Merneptah,  20 
Arthritis:  96,  164,  184,  212;   deformans, 

100, 119,  212-67 
Ashmolean  Museum,  49 
Assuan  dam,  50,  93,  225 
Atheroma,  27 
Atrophy,  17,  219 
Attrition  of  teeth,  159,  283 
Aulctcs,  351 


Bacteria,  6,  16,  33,  176 

Baldness,  173 

Bandages,  128,  177 

Baudouin,  Professor  Marcel,  185, 194,  307 

Beni-Hassan,  tombs  of,  47,  49,  210 

Bes,  the  god,  47 

Bilharzia  hematobia,  17,  18 

Biliary  calculi,  50 

Bitumen,  21,  54 

Blackheads,  173 

Bladder,  59 

Blood,  56 

Blood  vessels,  histological  examination  of, 

24 
Bos  primigcnius,  188 
Bouchard's  nodosities,  104,  132 
Brain,  141 

Breasted,  Professor  J.  H.,  37,  272 
Breccia,  Professor  E.,  3,  94,  139,  229,  270 
Broca,  Paul,  46,  199 
Bronze  period,  185,  198 

Cairo  Medical  School,  56,  83 

Cairo  Museum,  32,  38,  44,  66,  166 

Caithness,  prehistoric  remains  at,  show- 
ing pathology,  185 

Calcification  of  arteries,  25 

Calculi:   biliary,  50;   urinary,  n 

Caries:  144,  161,  291;  distribution  of, 
in  ancient  times,  292 

Cave  bear,  187 

Chatby,  94,  104,  270 

Chnoum-hotep,  the  dwarf,  37,  38,  48 

Chronological  table  of  kings,  358 

Chronology,  272 

Cleopatra  Thea,  347 

Cleopatra  III,  348 

Cleopatra  VII,  the  Great,  352 

Clubfoot,  42,  49,  178 

Cocheral,  195 

Coptic  bodies,  lesions  in,  96,  1 14,  139,  241 

Copts,  21,  96,  300 

Corpuscles,  absence  of  blood,  28,  56 

Coxa  vara,  216,  257 


■/"> 


37o 


INDEX 


Crocodile,  spondylitis  in  Miocene,  184 
Cuvier,  196 
Cynocephalus,  188 

Darwin,  Charles,  124 

Darwin,  George,  322 

Dead,  methods  of  preserving  the,  56,  140 

Decalcification,  22,  113 

Deformed  persons,  35,  42,  49 

Delta  of  the  Nile,  226 

Dental:   abscesses,  146;   anomalies,  273; 

lesions,  268 
Dentistry,  absence  of,  in  ancient  Egypt, 

I23,3i4 
Desiccation,  88 

Diastemae  in  ancient  Nubians,  277 
Diodorus  Siculus,  52,  324 
Dwarfs,  33-48 

Embalming:    51-56,   127;    incisions  in, 

56,  134;  materials,  59-61,  127 
Embolism,  27 
Exostoses,  100 

Faras,  156,  229,  308 

Fayoum  Pyramid,  98,  223 

Ferguson,  A.  R.,  32 

Food  of  ancient  Egyptians,  30,  124,  288 

Fouquet,  Dr.,  3,  54,  55,  93,  224 

Fractures,  96,  157,  162 

Gavial,  spondylitis  deformans  in  Miocene, 

184 
Greek  period,  diseases  of,  20,  55,  120,  228 

Haemoglobin,  61 

Hatshepsut  I,  Queen,  328 

Hearst  Expedition  of  the  University  of 

California,  66,  269 
Heart,  histological  examination  of  the, 

76, 141 
Heliopolis,  303 
Heredity,  322 
Hernia,  172 
Herodotus,  51 
Histology,  1,  11,  32,  49 
Hunchbacks,  35,  48,  49 
Hydrocephalus,  170 
Hyksos,  171,  326 
Hypertrophy,  150 


Idiocy,  322 
Ikhnaton,  168 
Insects,  99 

Intestines:    histological  examination  of, 
83;   methods  of  preservation  of,  58 

Jones,  Dr.  F.  Wood,  3,  117,  216,  257 

Kabyl  tribes,  201 

Kabylia,  201,  202 

Kawamil,  224 

Khebsennuf,  58 

Kidneys:     histological    examination    of, 

17,  19,  81;   method  of  preservation  of, 

57 
Kjoekken-moeddings,  224 
Kom  el  Shougafa,  179,  215,  232,  236,  372 

Le  Baron,  J.,  185 

Lesions,  osteo-arthritic,  185 

Liver:  histological  examination  of,  12,  77; 

method  of  preservation  of,  58,  142 
Looss,  Professor,  50 
Lordosis,  39,  45 
Lortet,  Professor,  3,  188 
Lozere,  196 

Lucas-Championniere,  199-206 
Lumbago,  213 
Lungs,  histological  examination  of,  15, 

79, 141 

Malaria,  151 

Malposition  of  teeth,  158 

Mammary  glands,  86 

Mandible,  122 

Marriages,      consanguineous,      physical 

effects  of,  322 
Maspero,  Sir  Gaston,  14,  46,  165 
Merawi,  156,  229,  287 
Meritamon,  Princess,  177 
Merneptah,  King,  167,  172,  173,  338 
Method,  in  technique,  1,  63 
Methods  of  preservation,  59 
Miocene,  pathological  vertebrae  from  the, 

184 
Monkeys,     spondylitis     deformans     in 

ancient  sacred,  188 
Mummery,  J.  R.,  268 
Mummies:    histology  of,   1,   15,  49-92; 

microscopic  examination  of,  1,  11,  20; 

royal,  166 


INDEX 


371 


Mummification,  20,  32 

Muscles,  histological  examination  of,  70 

Myrrha,  on  marriage,  323 

Nails,  method  of  preservation  of,  66,  70 

Natron,  51,  60 

Nefer,  teeth  of  Queen,  276 

Nefermaat,  96,  238 

Nefertari,  Queen,  326 

Neolithic  trephining,  195 

Nerves,  histological  examination  of,  72 

New  Caledonia,  209 

Nibsoni,  172 

Nodules  of  ancient  teeth,  281 

Nofritari,  Queen,  173 

Notmit,  Queen,  173 

Nubia,  118,  156,  245,  328 

Obesity,  167,  170 

Ossarium  of  Sedec,  198 

Osseous  lesions  in  ancient  Egyptians,  93- 

126,  147-50 
Osteo-arthritic  lesions,  212-67 
Osteomyelitis,  163 
Osteophytes,  212-67 
Osteosarcoma,  179 
Ovary,  143 
Overbites  in  ancient  Egyptians,  279 

Paleopathology,  definition  of,  139 

Papyrus,  Berlin  medical,  49 

Papyrus,  Ebers,  49 

Paralysis,  facial,  49 

Pathological  anatomy,  n,  166 

Penis,  59 

Periarthritis,  189 

Periodontitis,  161,  304,  306,  312 

Peroneal  artery,  atheroma  in,  25 

Persian  occupation,  102,  127 

Petrie,  Professor  Flinders,  n,  17,  40,  49, 

54,  96,  223 
Pettigrew,  53 
Phtah,  the  god,  47 
Poncet,  Professor,  3 
Pott's  disease,  3,  42 
Predynastic  mummies,  12 
Priest  of  Anion,  3,  54,  167 
Prunicre,  3,  196 
Psoas  abscess,  3 


Ptolemaic  kings,  341 

Ptolemy  I,  93,  341 

Ptolemy  II,  343 

Ptolemy  III,  344 

Ptolemy  IV,  345 

Ptolemy  V,  346 

Ptolemy  VI,  346 

Ptolemy  VII,  346 

Ptolemy  IX,  346 

Punt,  Queen  of,  44,  48 

Pyorrhoea  alveolaris,  177,  214,  307 

Pyorrhoea  marginalis,  306 

Ramses  II,  172,  173,  337 

Ramses  III,  167 

Ramses  V,  172,  175 

Ranefer,  liver  of,  12 

Ras  el  Tin,  215,  233,  279 

Raymonden,  184 

Rhinoceros,  pathology  in  Miocene,  189 

Rickets,  43,  47,  49,  313 

Rietti,  Arnoldo,  93,  186 

Roman  cemetery,  179 

Roman  period,  113,  123 

Rondelles,  195 

Royal  mummies,  pathology  of  the,  166-76 

Saknounra  Tionaken,  171 

Salt,  59,  60,  141 

Sarcolemma,  71 

Sawdust,  59 

Schmidt,  Professor,  56,  60,  61 

Sciatica,  213 

Scrotum,  59 

Seti  I,  172,  290,  337 

Shattock,  Mr.,  20 

Shellal,  225 

Simpson,  Hilton,  206-10 

Sinai,  Desert  of,  88 

Siptah,  178 

Skin,  32,  66,  175 

Skin,  histological  examination  of,  66 

Smallpox,  32,  175 

Smith,  Professor  G.  Elliot,  3,  ir,  32,  50, 

100,  165,  170,  172,  268 
Solutrean  period,  187 
Spleen:   143;  hypertrophy  of,  150 
Spondylitis    deformans:     96,    163,    184, 

188,  212-67;  in  sacred  sheep,  188 


372 


INDEX 


Steatopygia,  45,  49 

Stomach,  85 

Sudan, 156 

Surgery,  prehistoric,  195 

Sweat  glands,  68 

Syphilis,  29,  94,  158,  313 

Talipes  equino-varus,  42,  48,  178 
Teeth:    condition  of,  120,  131;    diseases 

of,  120,  268;  lesions  of,  144,  177 
Testicles,  85 
Thutmose  I,  328 
Thutmose  II,  167,  172,  174,  328 
Thutmose  III,  172,  174,  329,  330 
Thutmose  IV,  331 
Tiaa,  Queen,  331 
Tiy,  Queen,  332 
Tobacco,  29 
Tourah,  226,  303 
Trepanations,  multiple,  195,  197 
Trepanning,  194 


Trephining:    194;   absence  of,  in  Egypt, 

200;  prehistoric,  195 
Tuamantef,  the  jackal-headed,  80 
Tuberculosis  of  the  spine,  3,  42 
Tumor  of  the  pelvis,  179 

Ulcers,  174 
Urinary  calculi,  n 
Ursus  spelaeus,  187 

Variola,  32,  175 

Veddahs  of  Ceylon,  322 

Virchow  on  pathology  of  cave  bears,  187 

Viscera,  83 

Wainwright,  Gerald,  96 

Walther,  Ph.  von,  187 

Wear  of  teeth,  159,  282 

Willmore,  Dr.  J.  G.,  179,  212,  243,  257, 

268 
Wormian  bones,  158 


DUE  DATE 


COLUMBIA  UNIVERSITY  LIBRARIES  (hsl.stx) 

R  135  R83  1921  C.1 

Studies  in  the  paleopathology  of  Eg 


2002212692 


